Transcript Document

Navigating Pennsylvania Cancer
Patients (NPCP)
Demonstration Project
Appalachia Community Cancer
Network
Research Roundtable
September 28, 2007
Aileen S. Galley, ACSW, LSW
Session Objectives
 overview of MNMC
 detail types of patient navigation
 discuss PA DoH funding, FCCC collaboration
and shared goals
 review cancer burden data for Centre region
 case studies
 discuss successes and challenges to date
Overview of Mount Nittany Medical Center
• Founded in 1902 as a not for profit
• Moved to State College location in 1972 to PSU
Agricultural land
• 201 Beds
• Full 3 Year Accreditation by the Joint Commission for the
Accreditation of Hospitals
• Governed by a 16 member Volunteer Board of Trustees
• 4th largest employer in Centre County with 1,300 skilled
healthcare professionals and support staff
• > 240 non-employed physicians in 42 specialties
• Volunteers contribute > 54,000 hours/year
Cancer Care in the Centre Region
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MNMC is Penn State Cancer Institute founding member
Comprehensive Breast Care Center, Breast MRI
PET
RO: Prostate brachytherapy and HDR, IMRT, 1 physician,
1 PA-C; IGRT, stereo-tactic to come
Neuro-oncology: 1 physician, new MICU/SICU
GI: 4 physicians, 2 centers
Surgical oncology: 5 physicians, 2 groups
H&N surgeons: 2 physicians, 2 groups
New cancer center being planned
Cancer Program Overview
• Accredited by CoC of ACOS as Comprehensive
Community Cancer Center
• Year 2006: 754 patients accessioned
• 15,000 visits each year to Medical Oncology
• Over 17,000 treatments each year in Radiation Oncology
• Over 500 Sentinel Lymph Node biopsies for breast and
melanoma
• Over 14,000 patients entered in registry since reference
date of January 1, 1976
• dedicated inpatient oncology unit
• Expanding rural outreach to neighboring counties –
Huntingdon county to have access to clinical trials
Patient Navigation Models
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Clinical
Disease Specific
Physician practice based
Telephonic
Lay
Navigating PA Cancer Patients Program
• PA DoH RFA, “Model Patient Navigator System Initiative”
• FCCC initiative, Suzanne Miller, PhD, Linda Fleisher,
MPH, co-PI’s
• focus on underserved populations in Pennsylvania
• Compare rural vs. urban differences faced by patients and
navigators
• Begin at diagnosis – reduce delays in treatment, increase
treatment adherence
• provide a model paradigm based on an integration of “best
practices” in health education, case management and
training as well as state-of-the-science behavioral theory
and evaluation research
Demonstration Project Objectives
• enhance patient access to information about cancer
diagnosis
• facilitate location of health care services
• reduce delays and missed appointments
• provide information on the location of tangible
social services
• ultimate goal: improve cancer care among patients
in the Commonwealth.
Measurement of Outcomes
• Demonstration project 18 months in length
• # of barriers faced by patients
• Amount of time spent by navigator with each intervention
• Future recommendations: decrease time between
diagnosis and treatment; increase treatment compliance by
removing barriers, I.e. reduce # of missed appointments by
arranging transportation
• ultimate goal: improve cancer care among patients in the
Commonwealth.
Navigating PA Cancer Patients:
Participating Sites
PA Department of Health
Fox Chase Cancer Center
Suzanne Miller, PhD
Linda Fleischer, MPH
Co-PI's
Geisinger Medical Center
Henry Cancer Center, Wilkes Barre
Mohammed Mohiuddin, MD
PI - control arm
Temple University Hospital
Cancer Center - Urban arm
Nevena Damjanov, MD - original PI
Rocco Crescenzo, DO - current PI
Mount Nittany Medical Center
Richard Dixon, MD
PI - Rural arm
Navigating PA Cancer Patients:
Why MNMC? Cancer Burden Overview
New Cases 2006*
New Cancer Cases 2006
*Estimated from ACS Facts and Figures 2006
Female Breast
Lung
Colo-Rectal
National*
State*
Bladder
MNMC
Prostate
0
10
20
Percentage
*(only 5 cervical)
30
40
Navigating PA Cancer Patients:
Why MNMC? Cancer Burden Overview
Top Five Sites 2002-2006
# of Cases
Top Five Sites
180
160
140
120
100
80
60
40
20
0
2002
2003
2004
2005
2006
Breast
Prostate
Lung and
Bronchus
Colon and
Rectum
Bladder
Navigating PA Cancer Patients:
Why MNMC? Cancer Burden Overview
Defined as Metropolitan Statistical Area by USDA
The Center for Rural PA statistics
Estimated 2005 population 140,561 (vs. 12,429,616 PA)
Land area 1,108 square miles
Population: 123 per square mile
35.7% rural (vs. 23% for state) year 2000
Poverty rate 11.5% (2000)
Cancer Death rate low at 1.33% vs. 2.36% state
256 practicing physicians in county (176 with admitting privileges at
MNMC)
1 acute care facility: Mount Nittany Medical Center 201 beds
Program Implementation
• Navigator, Kristin D. Sides, hired 2/26/07 and
began orientation at Mount Nittany
• Began FCCC navigator training 3/5/07 – 3/16/07
• FCCC project mgr shadowed on-site on 3/29/07
• Meets weekly with cancer program director at
MNMC
• Weekly conferences with project manager and bimonthly calls with project manager and navigator
at urban site.
Quest for Referrals
• Medical Center – all departments
• Group Practices: outreach to med onc & surg onc groups,
rural and “central” pcp sites, specialists (I.e. GI)
• Community: CCCHS, CVIM, Tapestry (board), articles in
paper
• Support groups: Breast, Ostomy, Prostate, Lymphadema
• Physical space in RO, sees all new consults, on-treats,
follow-ups
• Daily visits to med onc office
• Seeing inpatients
• Reviewing pathology
• Cancer Registry “case finding”
Quest for Referrals:
Successful Strategies
Relationships
+ Results
+ Response Time
Improved Patient Outcomes
Increased Patient & Provider Satisfaction
Decreased Patient Anxiety
Current State – 7 months into project
• 11 patients enrolled on study
• 39 additional patients either not eligible for study (not one
of five sites), not interested/willing – 2 are pending
enrollment
• Navigator well integrated into program, respected and well
liked by staff
• Exploring future funding opportunities
• Next steps: letter from physicians to patients, physician
pocket cards, advertisements – requires IRB approval;
clinic visits in neighboring rural county (Huntingdon)
Case Studies
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Mary - 76 year old female, diagnosed with stage
IIIA Lung Cancer in November 2006.
Sue - 83 year old female diagnosed with stage
IIIC Ovarian Cancer in 2003.
Jane – 42 year old female diagnosed with
StageIIA Breast Cancer in 2000. Metastatic
recurrence diagnosed in January 2006. Now
stage IV disease.
Successes
 MNMC willingness for 1st grant funded position
 Background of navigator hired
 Referral sources agree with need, respect navigator
 Collaboration with case mgmt, CNS
 Service not limited to patients of MNMC
DoH & FCCC extending study beyond newly diagnosed
 Relationship with project mgr, PI, FCCC
 Patient satisfaction
 Enhanced outcomes for those patients referred
 Opportunity to create new paradigm for care
Challenges
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Medical Staff model
Medical Oncology access
Out of site, out of mind
Main practice not willing to refer
Patients with challenges not of 5 study sites
Demographic – MNMC prostate patients with a different
profile; almost no cervical cases
Research barriers – need help, don’t want/can’t participate
Urgency of some cases doesn’t allow adequate time to
review study goals
Newly diagnosed often overwhelmed with treatment
decisions, not prepared to consider study
Patient identification can be reactive, not proactive
Recommendations/Discussion
• Lay vs. Clinical models – future partnerships
• Navigator intervention at time of abnormal
finding
• Impact of navigation on cost of care
• Practice based navigation
• Potential for role overlap: clinical nurse
specialists, clinical coordinators, care/case
managers, social workers
• Role for navigation with long term survivorship
Aileen S. Galley
814-234-6787
[email protected]