Transcript Research Program

Comprehensive Thoracic
Oncology Program:
COG Update
CTOP Research Retreat
David Nalepinski
Director, Oncology Service Line & Business Operations
May 23, 2014
Conflict of Interest
I, David Nalepinski, have no conflict of interests
related to the material presented within this
presentation.
Objectives:
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The “Cancer Oncology Group”
Defining the Grey Zone
Aligning Priorities
CTOP Metrics
Next Steps
The Patient at the Center…
A couple of definitions….
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Clinical Microsystem: “a small group of people who work
together in a defined setting on a regular basis to provide
care and the individuals who receive that care”
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Surgery, HemOnc, RadOnc…. Organized by subspecialties,
sections and “cost centers”
Clinical Mesosystem:
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Connect microsystems, Surround microsystems..
Can HELP… or can HINDER microsystems
The Cancer Oncology Group (COG) is a mesosystem made up of
microsystems
Source: Value by Design: Developing Clinical Microsystems to Achieve Organizational Excellence
The Patient at the Center…
Referring
Providers/
Primary Care
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Prevention/Education/Pop Health
Screening
Referral
Nutrition/Rehab/Palliative
Research/Clinical Trials
Radiology
Pathology
Navigation/Care-Management
Supportive Services
Treatment
Modality
Surgery
Treatment
Modality
Chemotherapy
Treatment
Modality
Radiation
Treatment
Support
Survivorship
Referring
Providers/
Primary Care
VARIOUS SECTIONS
/DEPTS
Oncology
F/U
ANCILLARY
SERVICES
SECTION
RESOURCES
DOS
MICROSYSTEM
SECTION
RESOURCES
RADONC
MICROSYSTEM
CTOP MESO-SYSTEM
Tumor
Board
HEMONC
MICROSYSTEM
SECTION
RESOURCES
Diagnosis
THINK PROGRESSION/HORIZONTAL/LONGITUDINAL
Organization Vision – Market/Geopolitical System
Incentives: ACO, Quality/Cost, Capitation
Incentives: Episodes, FFS, wRVU’s, Cost/Unit
CTOP MESOSYSTEM
COG (Mesosystem) Successes!!
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Tumor boards
Clinical trials
Interdisciplinary clinics
Some pathway development
Patient focused providers and staff
Clear “financial impact” picture
Strong Q/S program
Concepts on the Cancer Center strategic plan
CTOP COG Metrics….
Lung Financial Trends….
Lung Financial Trends….
Lung Financial Trends….
Esophagus Financial Trends….
Esophagus Financial Trends….
Esophagus Financial Trends….
New Lung Cancer Patients
New Lung Cancer Patients
New Lung Cancer Patients
New Esophagus Cancer Patients
New Esophagus Cancer Patients
New Esophagus Cancer Patients
Lung Cancer Referrals (w/ Upper Valley)
Lung Cancer Referrals (w/o Upper Valley)
Esophagus Cancer Referrals (w/ Upper Valley)
Esophagus Cancer Referrals (w/o Upper Valley)
Next Steps…
Oncology Service Line Development
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Disease based
Multidisciplinary membership
Medical Director who is willing and able to
establish the mission, goals, processes and
procedures necessary to optimize the
group/program in the areas of patient care,
research, and education
Accountability to the Meso-System… the
COG
: Norris Cotton Cancer Center Clinical Organization Structure
Surgery Chair
NCCC Steering
Committee
Medicine Chair
Vice President
Center Director
Chief Radiation Oncology
Chief(s) Hematology Oncology
Center Deputy Director
Nursing Director
NCI-CCSG Admin
Director
Chair
Pathology
Chair
Radiology
NCI
Cancer Center Support Grant
Clinical Cancer Committee
Clinical Care Team
Breast
Surgery
Endocrine
GI
Colon/Liver/Pancreas
GU
Kidney/Prostate
Bladder/Testis
GYN
Head & Neck
Lymphoma
Cutaneous
Lymphoma
Patient
Conferences
(Tumor Boards)
Hematology
Pharmacy
Radiation
Care
Pathways
Radiology
Melanoma
Pathology
Neuro
Pediatric
Thoracic
Interdisciplinary
Clinics
Nursing
Esophagus/Lung
BMT
Spine
Care
Management
Care
Coordination
Palliation
Translational Research
Thyroid/Pituitary
Clinical Research
Cancer Oncology Group Directors
Comprehensive
Patient & Family Centered Care: Elements of Integrated & Coordinated Care
Referral
Suspected
Diagnosis
Patient
Intake
Patient
Conference
(Tumor
Board)
Interdisciplinary
Clinic
Cancer
Oncology
Group(s)
Patient Navigation
Care
Pathway
Decisions
Clinical Diagnosis
Treatment Schedule Coordination
Treatment Modalities
“Mini” Patient Care Conference(s)
Shared Decision
Care Management/Supportive Services/Palliation & EOL
Clinical Research
Education
Measurement: Quality and Safety
Measurement: Financial & Volume(s)
Survivorship
Electronic Medical Record (eDH)