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Cancer Fast Track e-Consults: An Innovative Approach to e-Consultation
Purpose: To improve access to specialty care for Veterans with a cancer concern and to improve communication among providers.
Background: Providers at the Cleveland VA Medical Center (CVAMC) voiced concerns that the process for Veterans with a cancer concern was fragmented, leading to potential delays in cancer diagnosis. The CVAMC developed an innovative process for the Cancer Fast Track Econsult (CFTE-C) to assist providers with expediting care for Veterans with a cancer concern. This process aims to improve communication between primary and specialty care providers, expedite pre-cancer workups, and allow more meaningful face to face first oncology specialty visits.
Methods: The E-consult is initiated by a primary care provider (PCP) in CPRS. After entering the CFTE-C an oncologist triages the consult to determine workup needed. The care coordinator (CC) ensures implementation of the plan of care and tracks its progression. This is done by the CC entering each Veteran into the Task Tracker (TT), a smart calendar that is used for communication and seamless coordination for selected Veterans. The CC continuously monitors the progression of diagnostic testing to ensure timeliness and identify delays. During the diagnostic process, the CC communicates the process to the PCP in CPRS. After cancer is confirmed or ruled out the CC discusses treatment plan with oncologist, documents in CPRS and notifies PCP.
Results: Since July 2015 there have been a total 145 veterans that have been referred to the CFTE-C. The average time from consultation to first action is 3 days. There is an average of about 6 CFTE-C consults monthly.
Implications: The CFTE-C process of using the TT allows the CC to monitor the Veterans workup and identify delays and barriers to care. The CC assists in eliminating any barriers or delays identified. The CFTE-C is underutilized by PCP’s and efforts are underway to improving utilization
by identifying a PCP champion in the outpatient clinics. There is also a need for clear measures of timeliness of care. Templated notes are in production to allow for clear tracking of the entire process including a clear handoff to PCP or referring provider.
Purpose: To improve access to specialty care for Veterans with a cancer concern and to improve communication among providers.
Background: Providers at the Cleveland VA Medical Center (CVAMC) voiced concerns that the process for Veterans with a cancer concern was fragmented, leading to potential delays in cancer diagnosis. The CVAMC developed an innovative process for the Cancer Fast Track Econsult (CFTE-C) to assist providers with expediting care for Veterans with a cancer concern. This process aims to improve communication between primary and specialty care providers, expedite pre-cancer workups, and allow more meaningful face to face first oncology specialty visits.
Methods: The E-consult is initiated by a primary care provider (PCP) in CPRS. After entering the CFTE-C an oncologist triages the consult to determine workup needed. The care coordinator (CC) ensures implementation of the plan of care and tracks its progression. This is done by the CC entering each Veteran into the Task Tracker (TT), a smart calendar that is used for communication and seamless coordination for selected Veterans. The CC continuously monitors the progression of diagnostic testing to ensure timeliness and identify delays. During the diagnostic process, the CC communicates the process to the PCP in CPRS. After cancer is confirmed or ruled out the CC discusses treatment plan with oncologist, documents in CPRS and notifies PCP.
Results: Since July 2015 there have been a total 145 veterans that have been referred to the CFTE-C. The average time from consultation to first action is 3 days. There is an average of about 6 CFTE-C consults monthly.
Implications: The CFTE-C process of using the TT allows the CC to monitor the Veterans workup and identify delays and barriers to care. The CC assists in eliminating any barriers or delays identified. The CFTE-C is underutilized by PCP’s and efforts are underway to improving utilization
by identifying a PCP champion in the outpatient clinics. There is also a need for clear measures of timeliness of care. Templated notes are in production to allow for clear tracking of the entire process including a clear handoff to PCP or referring provider.
Purpose: To improve access to specialty care for Veterans with a cancer concern and to improve communication among providers.
Background: Providers at the Cleveland VA Medical Center (CVAMC) voiced concerns that the process for Veterans with a cancer concern was fragmented, leading to potential delays in cancer diagnosis. The CVAMC developed an innovative process for the Cancer Fast Track Econsult (CFTE-C) to assist providers with expediting care for Veterans with a cancer concern. This process aims to improve communication between primary and specialty care providers, expedite pre-cancer workups, and allow more meaningful face to face first oncology specialty visits.
Methods: The E-consult is initiated by a primary care provider (PCP) in CPRS. After entering the CFTE-C an oncologist triages the consult to determine workup needed. The care coordinator (CC) ensures implementation of the plan of care and tracks its progression. This is done by the CC entering each Veteran into the Task Tracker (TT), a smart calendar that is used for communication and seamless coordination for selected Veterans. The CC continuously monitors the progression of diagnostic testing to ensure timeliness and identify delays. During the diagnostic process, the CC communicates the process to the PCP in CPRS. After cancer is confirmed or ruled out the CC discusses treatment plan with oncologist, documents in CPRS and notifies PCP.
Results: Since July 2015 there have been a total 145 veterans that have been referred to the CFTE-C. The average time from consultation to first action is 3 days. There is an average of about 6 CFTE-C consults monthly.
Implications: The CFTE-C process of using the TT allows the CC to monitor the Veterans workup and identify delays and barriers to care. The CC assists in eliminating any barriers or delays identified. The CFTE-C is underutilized by PCP’s and efforts are underway to improving utilization
by identifying a PCP champion in the outpatient clinics. There is also a need for clear measures of timeliness of care. Templated notes are in production to allow for clear tracking of the entire process including a clear handoff to PCP or referring provider.
National Comprehensive Cancer Network Distress Thermometer Versus Veteran Symptom Assessment Screen: Year in Review at the Cleveland VAMC
Purpose: To address concerns of the cancer committee (CC) and facility regarding the transition use of the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) to the Veteran Symptom Assessment Screen (VSAS).
Background: The Cleveland VA Medical Center (CVAMC) had used the NCCN DT since 2012. In March 2016, in conjunction with the Durham VAMC, the CVAMC began to pilot the VSAS screening tool to replace the NCCN DT. This initiative was an attempt to use one tool that could be used across all VAs to satisfy both The American College of Surgeon’s (ACOS) Commission of Cancer (CoC) accreditation as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification. The CVAMC locally added social elements of transportation, housing and insurance to the VSAS tool.
Methods: In March 2016 the Ear Nose and Throat (ENT) clinic continued to use the NCCN DT while the Oncology Clinics (OC) began to initiate the VSAS. In the CVAMC OC, Veterans that scored a 4 or greater on the VSAS tool in depression, anxiety, or distress or answered yes to transportation, housing, or insurance concerns had a Distress Screening Outpatient Consult entered into CPRS by the intake RN/LPN in clinic. The consultation was then signed off by the provider in clinic delivering care to Veteran that day. The consult was received, reviewed and completed by the oncology social worker (OSW) or the oncology behavioral health (OBH).
Results: In 2016 there were 162 NCCN DT distress screenings that were completed. 38% scored a 4 or above and required referral to OBH/OSW. Only 53% had complete documentation in CPRS. In contrast the VSAS in 2016 had 107 screenings that were completed. 31% required referral to OBH/OSW. 97% had complete documentation in CPRS.
Conclusions/Implications: This pilot project at the CVAMC allowed clear comparison between NCCN DT and VSAS tools. At our institution, the completion rate of the VSAS, referral and documentation process clearly was more effective than the NCCN DT process. Due to these outcomes the CC and facility made the decision to transition our distress screening process to the VSAS from the NCCN DT.
Purpose: To address concerns of the cancer committee (CC) and facility regarding the transition use of the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) to the Veteran Symptom Assessment Screen (VSAS).
Background: The Cleveland VA Medical Center (CVAMC) had used the NCCN DT since 2012. In March 2016, in conjunction with the Durham VAMC, the CVAMC began to pilot the VSAS screening tool to replace the NCCN DT. This initiative was an attempt to use one tool that could be used across all VAs to satisfy both The American College of Surgeon’s (ACOS) Commission of Cancer (CoC) accreditation as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification. The CVAMC locally added social elements of transportation, housing and insurance to the VSAS tool.
Methods: In March 2016 the Ear Nose and Throat (ENT) clinic continued to use the NCCN DT while the Oncology Clinics (OC) began to initiate the VSAS. In the CVAMC OC, Veterans that scored a 4 or greater on the VSAS tool in depression, anxiety, or distress or answered yes to transportation, housing, or insurance concerns had a Distress Screening Outpatient Consult entered into CPRS by the intake RN/LPN in clinic. The consultation was then signed off by the provider in clinic delivering care to Veteran that day. The consult was received, reviewed and completed by the oncology social worker (OSW) or the oncology behavioral health (OBH).
Results: In 2016 there were 162 NCCN DT distress screenings that were completed. 38% scored a 4 or above and required referral to OBH/OSW. Only 53% had complete documentation in CPRS. In contrast the VSAS in 2016 had 107 screenings that were completed. 31% required referral to OBH/OSW. 97% had complete documentation in CPRS.
Conclusions/Implications: This pilot project at the CVAMC allowed clear comparison between NCCN DT and VSAS tools. At our institution, the completion rate of the VSAS, referral and documentation process clearly was more effective than the NCCN DT process. Due to these outcomes the CC and facility made the decision to transition our distress screening process to the VSAS from the NCCN DT.
Purpose: To address concerns of the cancer committee (CC) and facility regarding the transition use of the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) to the Veteran Symptom Assessment Screen (VSAS).
Background: The Cleveland VA Medical Center (CVAMC) had used the NCCN DT since 2012. In March 2016, in conjunction with the Durham VAMC, the CVAMC began to pilot the VSAS screening tool to replace the NCCN DT. This initiative was an attempt to use one tool that could be used across all VAs to satisfy both The American College of Surgeon’s (ACOS) Commission of Cancer (CoC) accreditation as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification. The CVAMC locally added social elements of transportation, housing and insurance to the VSAS tool.
Methods: In March 2016 the Ear Nose and Throat (ENT) clinic continued to use the NCCN DT while the Oncology Clinics (OC) began to initiate the VSAS. In the CVAMC OC, Veterans that scored a 4 or greater on the VSAS tool in depression, anxiety, or distress or answered yes to transportation, housing, or insurance concerns had a Distress Screening Outpatient Consult entered into CPRS by the intake RN/LPN in clinic. The consultation was then signed off by the provider in clinic delivering care to Veteran that day. The consult was received, reviewed and completed by the oncology social worker (OSW) or the oncology behavioral health (OBH).
Results: In 2016 there were 162 NCCN DT distress screenings that were completed. 38% scored a 4 or above and required referral to OBH/OSW. Only 53% had complete documentation in CPRS. In contrast the VSAS in 2016 had 107 screenings that were completed. 31% required referral to OBH/OSW. 97% had complete documentation in CPRS.
Conclusions/Implications: This pilot project at the CVAMC allowed clear comparison between NCCN DT and VSAS tools. At our institution, the completion rate of the VSAS, referral and documentation process clearly was more effective than the NCCN DT process. Due to these outcomes the CC and facility made the decision to transition our distress screening process to the VSAS from the NCCN DT.
Electronic Consultation: An Efficient and Effective Way to Manage Hematology Consults
Purpose: To demonstrate our facility’s process of successful integration of hematology electronic consultations to provide patient-centered, efficient and effective outpatient specialty care.
Background: The hematology/oncology section lost a nurse practitioner in 2013. As a way to provide continued high quality and timely care to hematology patients, electronic consultation was broadly implemented within the section.
Methods: A comprehensive electronic consultation program was established as per the Specialty Care Transformation Initiative guidelines. All Hematology consults (face to face or electronic) are addressed by the section chief.
Results: Since 2012, the section has answered over 3,600 consults electronically. In 2016 there were a total of 1,160 electronic consults placed to the service. Each year since 2012 the percentage of outpatient hematology volume that is addressed by electronic consultations has increased. During 2016, 78% of outpatient hematology volume was addressed electronically. Additionally, 85% of those patients treated with electronic consultations did not require a face to face visit within the subsequent 12 months of initial electronic consultation. Based on zip code analysis of those Veterans who had electronic consultations in 2016, we estimated that there were over 1,200 hours of driving time and nearly 70,000 miles of driving distance saved.
Conclusions: Many VAMCs are using electronic consultation to provide efficient and patient-centered specialty care. Our center has quantified the impact of successful implementation and looks to share our experience with others. Additionally, during poster presentation we will provide a toolkit for implementation, to include templated consult notes for specific hematologic conditions.
Purpose: To demonstrate our facility’s process of successful integration of hematology electronic consultations to provide patient-centered, efficient and effective outpatient specialty care.
Background: The hematology/oncology section lost a nurse practitioner in 2013. As a way to provide continued high quality and timely care to hematology patients, electronic consultation was broadly implemented within the section.
Methods: A comprehensive electronic consultation program was established as per the Specialty Care Transformation Initiative guidelines. All Hematology consults (face to face or electronic) are addressed by the section chief.
Results: Since 2012, the section has answered over 3,600 consults electronically. In 2016 there were a total of 1,160 electronic consults placed to the service. Each year since 2012 the percentage of outpatient hematology volume that is addressed by electronic consultations has increased. During 2016, 78% of outpatient hematology volume was addressed electronically. Additionally, 85% of those patients treated with electronic consultations did not require a face to face visit within the subsequent 12 months of initial electronic consultation. Based on zip code analysis of those Veterans who had electronic consultations in 2016, we estimated that there were over 1,200 hours of driving time and nearly 70,000 miles of driving distance saved.
Conclusions: Many VAMCs are using electronic consultation to provide efficient and patient-centered specialty care. Our center has quantified the impact of successful implementation and looks to share our experience with others. Additionally, during poster presentation we will provide a toolkit for implementation, to include templated consult notes for specific hematologic conditions.
Purpose: To demonstrate our facility’s process of successful integration of hematology electronic consultations to provide patient-centered, efficient and effective outpatient specialty care.
Background: The hematology/oncology section lost a nurse practitioner in 2013. As a way to provide continued high quality and timely care to hematology patients, electronic consultation was broadly implemented within the section.
Methods: A comprehensive electronic consultation program was established as per the Specialty Care Transformation Initiative guidelines. All Hematology consults (face to face or electronic) are addressed by the section chief.
Results: Since 2012, the section has answered over 3,600 consults electronically. In 2016 there were a total of 1,160 electronic consults placed to the service. Each year since 2012 the percentage of outpatient hematology volume that is addressed by electronic consultations has increased. During 2016, 78% of outpatient hematology volume was addressed electronically. Additionally, 85% of those patients treated with electronic consultations did not require a face to face visit within the subsequent 12 months of initial electronic consultation. Based on zip code analysis of those Veterans who had electronic consultations in 2016, we estimated that there were over 1,200 hours of driving time and nearly 70,000 miles of driving distance saved.
Conclusions: Many VAMCs are using electronic consultation to provide efficient and patient-centered specialty care. Our center has quantified the impact of successful implementation and looks to share our experience with others. Additionally, during poster presentation we will provide a toolkit for implementation, to include templated consult notes for specific hematologic conditions.
CT-Guided Bone Marrow Aspiration and Biopsy Is a Safe and Feasible Option to Decompress Busy Hematology/Oncology Clinics
Purpose: To disseminate information regarding the Louis Stokes Cleveland VAMC process for CT guided bone marrow aspiration and biopsies (BMAB).
Relevant Background/Problem: With timely access to quality care at the forefront of many VA-based initiatives we sought to decrease wait times for new patients with hematology concerns. Upon review of clinic utilization we recognized that many established patients requiring BMAB were scheduled into a new patient slot to allow enough time for the procedure. At the same time, our colleagues in Interventional Radiology (IR) approached us regarding the feasibility of performing BMAB using CT guidance.
Methods: We performed a retrospective review of all BMAB done between September 2014 and August 2015 before the IR guided procedure was offered to determine number of procedures performed. We then examined those cases performed from September 2015 to June 2016 after rollout of IR guided BMAB to determine numbers of cases, location of procedure (IR versus Hematology/Oncology), operator (IR versus staff versus fellow), and complications.
Data Analysis: From September 2014 to August 2015, 211 BMAB were performed, averaging 17 per month. From September 2015 to June 2016, 207 BMAB were performed with an average of 20 per month. During the latter time period, 50% of BMAB were performed using IR guidance with the other 50% performed by either Hematology/Oncology staff or fellows. There were no complications reported regardless of location and operator. Exposure to radiation dose was extremely low.
Results: IR guided BMAB is a safe and feasible option for patients and Hematology/Oncology providers.
Implications: IR guided BMAB can be one option to decompress already overbooked Hematology/Oncology clinics and to provide quicker access to care for patients with newly diagnosed hematologic and oncologic conditions.
Purpose: To disseminate information regarding the Louis Stokes Cleveland VAMC process for CT guided bone marrow aspiration and biopsies (BMAB).
Relevant Background/Problem: With timely access to quality care at the forefront of many VA-based initiatives we sought to decrease wait times for new patients with hematology concerns. Upon review of clinic utilization we recognized that many established patients requiring BMAB were scheduled into a new patient slot to allow enough time for the procedure. At the same time, our colleagues in Interventional Radiology (IR) approached us regarding the feasibility of performing BMAB using CT guidance.
Methods: We performed a retrospective review of all BMAB done between September 2014 and August 2015 before the IR guided procedure was offered to determine number of procedures performed. We then examined those cases performed from September 2015 to June 2016 after rollout of IR guided BMAB to determine numbers of cases, location of procedure (IR versus Hematology/Oncology), operator (IR versus staff versus fellow), and complications.
Data Analysis: From September 2014 to August 2015, 211 BMAB were performed, averaging 17 per month. From September 2015 to June 2016, 207 BMAB were performed with an average of 20 per month. During the latter time period, 50% of BMAB were performed using IR guidance with the other 50% performed by either Hematology/Oncology staff or fellows. There were no complications reported regardless of location and operator. Exposure to radiation dose was extremely low.
Results: IR guided BMAB is a safe and feasible option for patients and Hematology/Oncology providers.
Implications: IR guided BMAB can be one option to decompress already overbooked Hematology/Oncology clinics and to provide quicker access to care for patients with newly diagnosed hematologic and oncologic conditions.
Purpose: To disseminate information regarding the Louis Stokes Cleveland VAMC process for CT guided bone marrow aspiration and biopsies (BMAB).
Relevant Background/Problem: With timely access to quality care at the forefront of many VA-based initiatives we sought to decrease wait times for new patients with hematology concerns. Upon review of clinic utilization we recognized that many established patients requiring BMAB were scheduled into a new patient slot to allow enough time for the procedure. At the same time, our colleagues in Interventional Radiology (IR) approached us regarding the feasibility of performing BMAB using CT guidance.
Methods: We performed a retrospective review of all BMAB done between September 2014 and August 2015 before the IR guided procedure was offered to determine number of procedures performed. We then examined those cases performed from September 2015 to June 2016 after rollout of IR guided BMAB to determine numbers of cases, location of procedure (IR versus Hematology/Oncology), operator (IR versus staff versus fellow), and complications.
Data Analysis: From September 2014 to August 2015, 211 BMAB were performed, averaging 17 per month. From September 2015 to June 2016, 207 BMAB were performed with an average of 20 per month. During the latter time period, 50% of BMAB were performed using IR guidance with the other 50% performed by either Hematology/Oncology staff or fellows. There were no complications reported regardless of location and operator. Exposure to radiation dose was extremely low.
Results: IR guided BMAB is a safe and feasible option for patients and Hematology/Oncology providers.
Implications: IR guided BMAB can be one option to decompress already overbooked Hematology/Oncology clinics and to provide quicker access to care for patients with newly diagnosed hematologic and oncologic conditions.
Use of the Community Needs Assessment (CNA) to Identify Barriers and Improve Access to Cancer Care for Veterans
Purpose: To disseminate information regarding The American College of Surgeons Commission on Cancer (ACOS COC) requirements of Patient Navigation that can be used across VAMCs.
Background: The ACOS COC requires that each facility determine a patient navigation process. The process must focus on a barrier to care identified within a Community Needs Assessment (CNA) that is administered at least every 3 years. From the results of the CNA, a patient navigation process can be developed to address patient, provider, or system barriers to care. These results are also presented to the Cancer Committee (CC) to compile a report summarizing the findings and implementing a plan to improve the quality of cancer care delivered.
Methods: A CNA questionnaire was reviewed by an interdisciplinary group consisting of oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse, 3 oncology nurse care coordinators and the Cancer Center Program Administrator. The questionnaire was formatted for ease of reading and comprehension. The group presented the CNA questionnaire to the CC for review and approval. The questionnaire was distributed and completed by Veteran’s at varying stages along the cancer trajectory.
Data Analysis: The questionnaire was distributed and completed by 50 Veterans from Feb 2014-Sept 2014. The questionnaires were distributed and collected in the chemotherapy infusion clinic, during outpatient clinic visits, and during the Louis Stokes Cleveland VAMC (LSCVAMC) annual Cancer Fair.
Results: The top rated concern was found to be travel. According the National Cancer Data Base (NCDB) generated in May 2015 shows that from the years of 2007-2012, 34% of Veterans receiving their care at the LSCVAMC traveled between 50-99 miles to receive their cancer care. The data were presented to the CC, and plans were made to further look at travel resources and community services available to our Veterans. A comprehensive report addressing resources was compiled and presented to the CC.
Implications: Identifying and breaking down barriers to transportation is vital to improving access to Veteran’s cancer care.
Purpose: To disseminate information regarding The American College of Surgeons Commission on Cancer (ACOS COC) requirements of Patient Navigation that can be used across VAMCs.
Background: The ACOS COC requires that each facility determine a patient navigation process. The process must focus on a barrier to care identified within a Community Needs Assessment (CNA) that is administered at least every 3 years. From the results of the CNA, a patient navigation process can be developed to address patient, provider, or system barriers to care. These results are also presented to the Cancer Committee (CC) to compile a report summarizing the findings and implementing a plan to improve the quality of cancer care delivered.
Methods: A CNA questionnaire was reviewed by an interdisciplinary group consisting of oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse, 3 oncology nurse care coordinators and the Cancer Center Program Administrator. The questionnaire was formatted for ease of reading and comprehension. The group presented the CNA questionnaire to the CC for review and approval. The questionnaire was distributed and completed by Veteran’s at varying stages along the cancer trajectory.
Data Analysis: The questionnaire was distributed and completed by 50 Veterans from Feb 2014-Sept 2014. The questionnaires were distributed and collected in the chemotherapy infusion clinic, during outpatient clinic visits, and during the Louis Stokes Cleveland VAMC (LSCVAMC) annual Cancer Fair.
Results: The top rated concern was found to be travel. According the National Cancer Data Base (NCDB) generated in May 2015 shows that from the years of 2007-2012, 34% of Veterans receiving their care at the LSCVAMC traveled between 50-99 miles to receive their cancer care. The data were presented to the CC, and plans were made to further look at travel resources and community services available to our Veterans. A comprehensive report addressing resources was compiled and presented to the CC.
Implications: Identifying and breaking down barriers to transportation is vital to improving access to Veteran’s cancer care.
Purpose: To disseminate information regarding The American College of Surgeons Commission on Cancer (ACOS COC) requirements of Patient Navigation that can be used across VAMCs.
Background: The ACOS COC requires that each facility determine a patient navigation process. The process must focus on a barrier to care identified within a Community Needs Assessment (CNA) that is administered at least every 3 years. From the results of the CNA, a patient navigation process can be developed to address patient, provider, or system barriers to care. These results are also presented to the Cancer Committee (CC) to compile a report summarizing the findings and implementing a plan to improve the quality of cancer care delivered.
Methods: A CNA questionnaire was reviewed by an interdisciplinary group consisting of oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse, 3 oncology nurse care coordinators and the Cancer Center Program Administrator. The questionnaire was formatted for ease of reading and comprehension. The group presented the CNA questionnaire to the CC for review and approval. The questionnaire was distributed and completed by Veteran’s at varying stages along the cancer trajectory.
Data Analysis: The questionnaire was distributed and completed by 50 Veterans from Feb 2014-Sept 2014. The questionnaires were distributed and collected in the chemotherapy infusion clinic, during outpatient clinic visits, and during the Louis Stokes Cleveland VAMC (LSCVAMC) annual Cancer Fair.
Results: The top rated concern was found to be travel. According the National Cancer Data Base (NCDB) generated in May 2015 shows that from the years of 2007-2012, 34% of Veterans receiving their care at the LSCVAMC traveled between 50-99 miles to receive their cancer care. The data were presented to the CC, and plans were made to further look at travel resources and community services available to our Veterans. A comprehensive report addressing resources was compiled and presented to the CC.
Implications: Identifying and breaking down barriers to transportation is vital to improving access to Veteran’s cancer care.
The Veteran Symptom Assessment Screen (VSAS) as an Alternate for the National Comprehensive Cancer Network (NCNDT) Distress Thermometer
Purpose: To utilize a distress screening tool that can be used across VAMCs that fulfills cancer center requirements and accreditation standards.
Background: The American College of Surgeon’s (ACOS) Commission on Cancer (COC), Standard 3.2 Distress Screening requires all new cancer diagnoses be screened at diagnosis and at pivotal points across the cancer care continuum. The Louis Stokes Cleveland VAMC (LSCVAMC) used the NCCN DT from May 2012 through March 2016. Collaborating with the Durham VAMC, the LSCVAMC began to pilot the VSAS screening tool in place of the NCCN DT. This initiative was an attempt to use 1 tool that could satisfy both ACOS COC accreditation standards as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification.
Methods: An interdisciplinary team composed of an oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse and the Cancer Center Program Administrator gathered to compare elements of both the NCCN DT and the VSAS tool. Social elements of distress related to transportation, housing and insurance deemed important to our veteran population were incorporated into the existing VSAS tool.
Data Analysis: During March through June 2016 there have been 47 VSAS tools completed on 47 unique patients. Nursing staff administer, document, and order applicable consults for the screening process. The time required to complete the screen is approximately 2-4 minutes depending on the complexity of the patient. Preliminary data regarding specific elements of the VSAS will be forthcoming at the time of poster presentation.
Results: Patients with a new diagnosis of cancer were asked to complete the form at their initial visit. Initial results from the team piloting the VSAS found that the tool actually allowed providers to hone in on more of the areas that were causing the Veteran the most distress. Whereas, with DT only having 1 thermometer made narrowing down what was causing the most distress more difficult.
Implications: Finding tools that can be implemented across VA facilities for both COC and QOPI initiatives will streamline processes and allow for multicenter data collection benefiting the VA as a whole and decreasing variability in cancer care between facilities.
Purpose: To utilize a distress screening tool that can be used across VAMCs that fulfills cancer center requirements and accreditation standards.
Background: The American College of Surgeon’s (ACOS) Commission on Cancer (COC), Standard 3.2 Distress Screening requires all new cancer diagnoses be screened at diagnosis and at pivotal points across the cancer care continuum. The Louis Stokes Cleveland VAMC (LSCVAMC) used the NCCN DT from May 2012 through March 2016. Collaborating with the Durham VAMC, the LSCVAMC began to pilot the VSAS screening tool in place of the NCCN DT. This initiative was an attempt to use 1 tool that could satisfy both ACOS COC accreditation standards as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification.
Methods: An interdisciplinary team composed of an oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse and the Cancer Center Program Administrator gathered to compare elements of both the NCCN DT and the VSAS tool. Social elements of distress related to transportation, housing and insurance deemed important to our veteran population were incorporated into the existing VSAS tool.
Data Analysis: During March through June 2016 there have been 47 VSAS tools completed on 47 unique patients. Nursing staff administer, document, and order applicable consults for the screening process. The time required to complete the screen is approximately 2-4 minutes depending on the complexity of the patient. Preliminary data regarding specific elements of the VSAS will be forthcoming at the time of poster presentation.
Results: Patients with a new diagnosis of cancer were asked to complete the form at their initial visit. Initial results from the team piloting the VSAS found that the tool actually allowed providers to hone in on more of the areas that were causing the Veteran the most distress. Whereas, with DT only having 1 thermometer made narrowing down what was causing the most distress more difficult.
Implications: Finding tools that can be implemented across VA facilities for both COC and QOPI initiatives will streamline processes and allow for multicenter data collection benefiting the VA as a whole and decreasing variability in cancer care between facilities.
Purpose: To utilize a distress screening tool that can be used across VAMCs that fulfills cancer center requirements and accreditation standards.
Background: The American College of Surgeon’s (ACOS) Commission on Cancer (COC), Standard 3.2 Distress Screening requires all new cancer diagnoses be screened at diagnosis and at pivotal points across the cancer care continuum. The Louis Stokes Cleveland VAMC (LSCVAMC) used the NCCN DT from May 2012 through March 2016. Collaborating with the Durham VAMC, the LSCVAMC began to pilot the VSAS screening tool in place of the NCCN DT. This initiative was an attempt to use 1 tool that could satisfy both ACOS COC accreditation standards as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification.
Methods: An interdisciplinary team composed of an oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse and the Cancer Center Program Administrator gathered to compare elements of both the NCCN DT and the VSAS tool. Social elements of distress related to transportation, housing and insurance deemed important to our veteran population were incorporated into the existing VSAS tool.
Data Analysis: During March through June 2016 there have been 47 VSAS tools completed on 47 unique patients. Nursing staff administer, document, and order applicable consults for the screening process. The time required to complete the screen is approximately 2-4 minutes depending on the complexity of the patient. Preliminary data regarding specific elements of the VSAS will be forthcoming at the time of poster presentation.
Results: Patients with a new diagnosis of cancer were asked to complete the form at their initial visit. Initial results from the team piloting the VSAS found that the tool actually allowed providers to hone in on more of the areas that were causing the Veteran the most distress. Whereas, with DT only having 1 thermometer made narrowing down what was causing the most distress more difficult.
Implications: Finding tools that can be implemented across VA facilities for both COC and QOPI initiatives will streamline processes and allow for multicenter data collection benefiting the VA as a whole and decreasing variability in cancer care between facilities.