Transcript Cancer Program Standards 2012: Ensuring Patient

Cancer Program Standards
2012: Ensuring PatientCentered Care
Stephen Dreyer, MD, FACS
October 22, 2014
CoC Surveyor
Fremont Health Medical Center
Fremont, Nebraska
Evolution of Program Standards
• Cancer Program Standards prior to 2004
– Focused on structure and process to assure uniformity of
care
• Studies questioned Healthcare delivery system and the quality
of care
– Fragmented, poorly coordinated
– Variability of care process
– Adversely affected outcomes
• National dialog on Quality of Care placed a strong emphasis
on outcomes of health care activities. (4)
Cancer Program Changes
• New focus on outcomes and delivering patient
centered care meant that program standards
needed to be revised
– Support concept of quality care
• Clinical stage – treatment plan - outcome
– Expand the concept of care to provide
individualized patient support
– Data quality improved
– Reporting tools need to be developed
– Measurable - analyzed and improved
Commission on Cancer’s Response:
‘Cancer Program Standards 2012: Ensuring Patient-Centered Care’
Focus on quality of care via
performance metrics quality
improvement. Deliver in
patient centered manner.
- Genetic assessment and counseling
- Palliative care services
- Increase clinical trial accruals
- Prevention and early screening
- Studies of quality and improvements
- Public reporting of outcomes
- Patient navigation (2015)
- Psychosocial distress screening
(2015)
-Survivorship care plan (2015)
-Patient centered manner
Benefits of Patient-Centered Standards
• Support customization of care each individual
according to needs and circumstances (tool box)
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Access
Decision making
Support during treatment
Survivorship
• Respond to the specific needs of a community
reduce the burden of cancer
• Incidence and stage of disease
• Strengthens the partnership between public and
healthcare system.
Patient Outcomes
Standard 4.1 Prevention
Standard 4.2 Screening
Prevention Programs
• S 4.1 Each year the cancer committee provides
at least 1 cancer prevention program that is
targeted to meet the needs of the community
and should be designed to reduce the
incidence of a specific cancer type. The
prevention program is consistent with
evidence based national guidelines for cancer
prevention.
Prevention Programs
• Examples of cancer prevention programs:
– Chemoprevention programs
– Education/cancer awareness
– Skin cancer prevention
– Smoking cessation
– Smoking prevention in adolescents
– Nutrition, physical activity, and weight loss
programs
– Vaccination for HPV
Effective Prevention Program
• Improve the health of a community reducing
incidence
• Identify community need
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Study top 5 cancer sites
state cancer registry
NCI - http://statecancerprofiles.cancer.gov/
Factors and behaviors that could be altered reduce
risk
• Prevention activity should be based on a
nationally recognized guideline
• Activity is documented and results are analyzed
Incidence Lung Cancer Polk County
Incidence Lung Cancer by County
Elements of a Guideline
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Study of the population
Defined invention is planned
Goal is established
Analysis of results
Cancer Prevention Guidelines
• http://www.ncbi.nlm.nih.gov/books/
• Search
• Tobacco cessation
– Adults cessation
– Youth prevention
• Quick Start Guide
– Browse by Title
– Filter term
NCI Books
NCI Book - Tobacco
NCI Books
• http://www.ncbi.nlm.nih.gov/books
– http://www.ncbi.nlm.nih.gov/books/NBK63
952/
– http://www.ncbi.nlm.nih.gov/books/NBK22
3926/
– http://www.ncbi.nlm.nih.gov/books/NBK22
3918/#ddd00119
Guideline Clearing House
• http://www.guideline.gov/
• Search on home page – tobacco cessation
– Treatment of tobacco dependence
– Smoking cessation services in primary care
– Counseling and intervention in adults and pregnant
women
• Search
– Organization
• American Cancer Society
– Topic
National Guideline Clearinghouse
List of Guidelines
Additional Resources
• Agency for Healthcare Research and Quality
• http://www.ahrq.gov/professionals/cliniciansproviders/guidelinesrecommendations/index.html
– Treating tobacco use and dependence
– Guide to clinical preventive services
Implement Prevention Programs
• Tobacco Cessation
– team with other medical specialists tobacco affects
outcome of the disease process
– Incorporate smoking cessation activities into the routine
treatment process
– Pick new site each year
– Periodically review the outcome and make improvements
• Hospital community
• Youth prevention
Implement Prevention Programs
• Breast
– Obesity and breast cancer risk
• Annual mammogram
• American Cancer Society information
– High risk group identified for chemoprevention
• Skin cancer
– Incidence of melanoma
Implement Prevention Programs
• Prevention programs continued the next year
– Continuing need
– Results can be improved
• Education and cancer awareness lectures
– Audience assessed for increased knowledge and
need for action
• Community needs assessment
– Presented to the cancer committee and date
– Used to select site and activity
Documentation for Compliance
• Evidence in minutes
– Cancer committee has assessed cancer prevention
needs of the community
– At least 1 prevention program has been conducted
– Prevention program is consistent with an evidence
based guideline and intervention
– Results of the activity are evaluated by the cancer
committee
Prevention Outcomes
• Measure, analyze, and improve – change
• Short term
– Numbers of participants
– Goal met
– Effectiveness of education programs increasing
knowledge and action
• Long term
– Reduction in the incidence of a specific site
Screening Program
• S 4.2 Each year, the cancer committee
provides at least 1 screening program that is
targeted toward decreasing the number of
patients with late stage disease. The screening
program is based on community needs and is
consistent with evidence based national
guidelines and interventions. A process is
developed to follow up on all positive findings.
Effective Screening Program
• Support concept of quality care
– Clinical stage – treatment plan – outcome
• Identify area of need specific to service area of
the cancer program
• Establish an effective screening program
– Conducted according to an established guideline
– Deal with positive results
Community Need (Study)
• Focus activities in sites with high number of
late stage disease and specific patient groups
• NCDB
– Benchmark reports
– Comparative studies
– Number of variables
Stage by Age Group
Enter Your Text Here (if any)
©2009 National Cancer Data Base - Generated on Sep-11-2013
Study Program Screening Results
Screening Guidelines
• American Cancer Society
• National Comprehensive Cancer Network
• Centers for Disease Control and Prevention
Documentation for Compliance
• Evidence in minutes
– Cancer committee identifies cancer screening
needs of the community
– At least 1 screening program has been conducted
– Screening program is consistent with an evidence
based guideline and intervention
– Process is developed to deal with all positive
findings
– Results of the activity are evaluated by the cancer
committee
Screening Outcomes
• Measure, analyze, and improve – change
• Short term outcome
– Numbers
• First time screening
• Participate in annual screening
• Interval between screenings
– Number with positive results referred
• Long term outcome
– Increased numbers of early stage disease
Questions?
Thank You