Transcript Jeanine Stiles - Markey Cancer Center

Cancer Center Administrators Forum
March 31, 2015
Jeanine Stiles
Chief Administrative Officer
Associate Director for Administration
ONE HEALTH, ONE VISION
Lost in Transition After Cancer
“The medical system that saved my life wasn’t able to help
me not want to take my life… I have developed a deep
love and reverence for the oncologists and nurses, and I
believe that these people really do understand that, in
some ways, it never ends for us. But I also believe that
collectively the system of care failed to prepare me for the
mental health crisis that I would experience.”
“There’s no excuse for that.”
“While an increasing number of cancer treatment
centers have begun offering post-treatment care
plans and support groups to help patients navigate
these challenges, many patients continue to fall
through the cracks. “Sometimes we do a good job of
preparing people for this, but often we don’t,” Dr.
Oeffinger said. “We need to do a better job.”
ONE HEALTH, ONE VISION
Building Supportive Oncology/Psycho-Oncology Programs
“We like to think of the end of cancer treatment as the closing of
a chapter, but what most people don’t realize is that the
emotional struggle continues long after,” Dr. Kevin C. Oeffinger,
a primary care physician and director of Memorial Sloan
Kettering Cancer Center’s adult long-term follow-up program,
told me recently over the phone. “Feelings of post-treatment
depression and anxiety are amazingly normal. I would go so far
as to say that if you don’t have them it’s a surprise.”
Suleika Jaouad
Cancer Survivor
Full story New York Times: Lost in Transition After Cancer:
http://mobile.nytimes.com/blogs/well/2015/03/16/lost-in-transition-after-cancer
ONE HEALTH, ONE VISION
It’s the Right Thing to do for Patient Centered Care
Commission on Cancer New Standards for ACoS
Accreditation
• Patient Navigation Process - 3.1
• Distress Screening - 3.2
• Survivorship Care Plan - 3.3
The importance of identifying and addressing supportive care
needs of cancer patients is widely recognized as a core component
of high-quality cancer care. The IOM asserts that “...health care
systems that are involved in cancer care should explicitly
incorporate attention to psychosocial needs into their policies,
practices and standards (Adler).” Despite this, supportive care
needs of cancer patients too often go undetected and untreated.
The IOM concludes that cancer care delivery systems in the
US are in crisis.
ONE HEALTH, ONE VISION
UCDCCC – Other NCI Designated Cancer Centers
ONE HEALTH, ONE VISION
UCDCCC Staff Satisfaction
% of Staff Satisfied or
Very Satisfied
Staff Satisfaction Survey
Overall
GOAL
Staff Support
Meeting needs
Access to care
0%
20%
40%
60%
80%
100%
• Overall staff satisfaction rate was
29%
• Staff satisfaction rate goal is
90%
• Dissatisfaction was highest
around issues of patient
access to supportive care.
ONE HEALTH, ONE VISION
It takes a Team
Angie Usher, LCSW
Jena Cooreman, LCSW
Jeanine Stiles, CAO
Julie Giannini, RN
Nathan Fairman, MD
ONE HEALTH, ONE VISION
The Journey
City Of Hope Training
3 day workshop
Matthew J. Loscalzo, L.C.S.W.
Executive Director, Supportive Care Medicine
Administrative Director, Sheri & Les Biller
Patient and Family Resource Center
Liliane Elkins Professor in Supportive Care
Programs, Endowed Professor
Professor, Population Sciences
Lots of Homework to do…..
ONE HEALTH, ONE VISION
Internal Partnerships
Department of Psychiatry/Hematology-Oncology/
Primary Care/Public Health Sciences
– Support of a Psychiatric Clinic within the Cancer Center
– Joint recruitment of Psycho/Oncologist – current
recruitment
– Buy in from Medical Oncologist
– Partnerships with primary care MD’s for Survivors Clinic
– Education vehicle for primary care MD’s
– Outcomes Research in concert with Public Health
Sciences
ONE HEALTH, ONE VISION
Making the Case
Distress Screening Pilot
• A 6-month, IRB approved, distress screening pilot study
of 358 Cancer Center patients was completed in
February 2014.
• Screening Tool: National Comprehensive Cancer
Network Distress Thermometer and adapted problem
checklist
• Process:
– Patients rate their current level of distress on a scale from 0 to 10
– Causes of distress assessed using 39-item problem checklist
– Patients scoring 5 or above referred to social services for
assessment
ONE HEALTH, ONE VISION
Results of Screening Pilot
38%
40%
0-2 minimal distress
3-4 moderate distress
5-10 high to severe distress
% reporting a problem
Reported Distress Levels
n=358
Frequency of Reported Problems
for patients with high to severe distress
n = 136
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
82%
82%
Emotional
Problems
Physical
Problems
60%
35%
Practical
Problems
Family
Problems
Problem Area
22%
38% of patients reported high to severe levels of distress
30% were referred to social services
38% of patients reported high to severe levels of distress
30% were referred to social services
Current staffing (1.75 FTE) meets approximately 10.5% of the need for
psychosocial services among highly distressed new patients.
ONE HEALTH, ONE VISION
Focus Groups
Cancer Survivors’ Focus Group
• April 2014 - focus group of cancer survivors was
conducted with the following goals:
– Identify common areas of concern among cancer survivors
– Use information to guide development of survivorship care
• Most prevalent emergent themes included concerns
about:
–
–
–
–
access to supportive care services,
care coordination between different services
provision of emotional support
Supportive care services felt to be of high quality but
insufficient to meet patient need
ONE HEALTH, ONE VISION
Why Invest – Benefits to Patient
• Reduced emotional distress and improved
quality of life (Faller et. al., 2013)
• Improved patient and family communication and
coping skills (Graves, 2003)
• Reduced barriers to patient care
• Improved patient investment in and acceptance
of diagnosis, treatment goals and prognosis
• Increased access to community supportive
resources
ONE HEALTH, ONE VISION
Why Invest – Benefits to Providers
• Addressing the psychosocial needs of distressed
clinic patients in real time allows physician to
maintain clinic schedule with minimal disruption
• Assistance in communicating information to
patients and families
• Filters distractions from disease-specific care
• Easily accessible, dependable compassionate
experts who help patients and support doctors
• Address complex psychosocial problems for
which doctors do not have time or training
ONE HEALTH, ONE VISION
Why Invest – Benefits to Health System
• Brings UCDHS into alignment with national standards /
guidelines for quality cancer care
• Models several goals of the UCDHS Strategic Plan
• Reduces healthcare costs and increases revenues
– Psychotherapeutic interventions correlated to subsequent reduction
in health care use. Reductions are more prominent for high utilizers
(Lane; Sobel; Crane, et al)
– Cancer patients with mild to significant mood disturbance have
increased utilization rates of hospital care and can raise medical
costs up to 250% (Carlson & Bultz)
– A meta-analytic review of the impact of psychological interventions
on health care utilization, found an average 20% savings resulting
from psychological interventions (Chiles, et al)
– Cost of providing therapeutic interventions has been shown to be
offset by medical cost savings over time (Lechnyr; Guthrie, et al)
ONE HEALTH, ONE VISION
FTE Requested
Proposal Submitted to Health System Leadership
December 2014
Supportive Oncology Services: Requested Additional Staffing
Staff
2014 FTE
current staff
2015 FTE
request
Psychiatrist
0.2
0.4*
Adult LCSW
1.75
3.0
Nurse Practitioner
2016 FTE
request
Total FTE
request
2.0
5.0
1.0
Adult RD
0.6
1.4
Pediatric LCSW
0.5
0.5
1.0
2.0
3.4
0.5
Pediatric RD
0.4
0.6
1.0
Child Life Specialist
1.0
1.0
Practical Assistance
Coordinator
1.0
1.0
Total of 13 FTE’s requested
ONE HEALTH, ONE VISION
Survivorship
A report last year by the American Cancer Society, in
collaboration with the National Cancer Institute, estimates there
are almost 14.5 million cancer survivors alive in the United
States today, and that number will grow to almost 19 million by
2024. Although more and more Americans are surviving cancer
thanks to early detection programs, new treatment regimens and
awareness campaigns, much remains to be learned about the
short- and long-term issues faced by survivors. With long-term
survival comes a new challenge: how to keep cancer survivors
healthy and emotionally stable after treatment ends.
ONE HEALTH, ONE VISION
Establishing A Survivors Clinic
• Provide patients the environment to address and
deal with latent side affect, emotional support, Not
lost in Transition
• Develop survivorship care plans – EMR tool.
• Allow oncologist to see newly diagnosed
• MD champion in survivor issues and side affects
• Ability to develop a robust program for outcomes
research
• External advisor for survivor issues
• External advisor for Health Services Research
• Hiring of a dedicated QA RN
ONE HEALTH, ONE VISION
Implementation Plan
YEAR 1:
• Design and develop a module in EMR for data capture of distress and nutrition
screening
• Design and implement supportive oncology plan of care
• Communicate importance of supportive oncology services to patients and
family
• Create a survivorship clinic to address end-of-treatment needs and assist in
transition to primary care
• Develop practical assistance services to quickly and efficiently address
concrete patient needs
• Identify psychosocial needs of new patients through distress screening
• Identify nutritional needs of new patients through routine screening
• Create clear clinical pathways to supportive care services
• Provide supportive oncology education to providers and staff
• Identify opportunities for community partnerships to improve access to services
and resources
ONE HEALTH, ONE VISION
Implementation Plan
YEAR 2:
•
•
•
•
•
•
Conduct follow-up, reevaluation and adjustment of supportive oncology
plan of care
Expand distress screening to include follow-up screening at pivotal
points of treatment
Expand nutritional screening to include follow-up patients
Continue to increase access to services through internal development
and community partnerships
Introduce psychotherapy services for patients utilizing LCSW staff in
lieu of licensed psychologists
Quality oversight
ONE HEALTH, ONE VISION
How We Will Measure Our Impact
• A Project to Assure Quality Cancer Care (APAQCC)
• UCDCCC has been accepted as a participant to this research
project being conducted by the Association of Oncology Social
Work
• The purpose of this project is to:
– Improve the psychosocial care received by cancer patients and their
families
– Provide social workers with tools and skills to implement and monitor
psychosocial care, particularly distress screening, and adhere to
standards of care (American College of Surgeons, QOPI)
– Inform Social Work practice and provide data to advocate for resources
(e.g., programmatic support, staffing)
• Participants in APAQCC will:
– Assess their institution’s capacity for providing psychosocial support
services and compare it to other similar institutions
– Use data for quality improvement and enhancement of support service
delivery
ONE HEALTH, ONE VISION
Drinks with Shrinks
ONE HEALTH, ONE VISION
Kentucky Has Nothing Over California
ONE HEALTH, ONE VISION