The Everett Clinic @ Providence Regional Cancer Partnership

High Value Cancer Care

Marilyn Birchman, RN, MSN, AOCNSRegional Director, PRCP

Kelly Mardesich, RN, BSN, MHA (c)Clinical Practice Manager, TEC

Renee Curtis, PharmD, BCOPManager, Clinical Pharmacy, TEC

May 3, 2018Presentation from HICOR Value in Cancer Care Summit 2018 - Please cite author when referencing content

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Goal of Cancer Care

• Value= Quality /Total Cost.

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PRCP: FOCUS on QUALITY

• American College of Surgeons Commission on Cancer—Outstanding Achievement Award – 2 consecutive awards - uniqueachievement

• National Accreditation Program for Breast Centers (NAPBC)

• Quality Oncology Practice Initiative (QOPI) participant since 2006and QOPI Certified since 2014

• Hutchinson Institute for Cancer Outcomes Research (HICOR)

• Stanford Study participant

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Critical Lessons From High-Value Oncology Practices

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HICOR/Stanford Study- PRCP/high value practice

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• Unique Attributes of High-Value Practices– Treatment Planning: A Conservative Approach to Diagnostic Testing:

– Treatment Planning: Setting Goals After Explicit Discussion on the Benefits,Limits, and Consequences:

– Support for the Patient Journey:

– Care Team Functions at the Highest Level of Competence and License:

– External Context: Close affiliation with a large and generally hospital-basedhealth system.

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How did we do it?

• Very little data

• Follow Core Values

• Focus on Quality

• Teamwork

• Results will follow

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Hospitalization during chemotherapy Presentation from HICOR Value in Cancer Care Summit 2018 - Please cite author when referencing content

Hospitalization During Chemotherapy

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Low rates for ED & inpatient admits

Physician buy-in is critical

Support of department leadership decisions

Must be trust in nursing staff to make independenttriaging decisions

Trust and respect for clinical decision-making ofadvanced practitioners, including clinical pharmacy

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Building a culture within nursing

TEC #1 Core Value – do what is right for the patient

RN works at top of license –Stanford study“maximal use of registered nurses for

interventions”

Keep patient out of the ED, whenever possible Patients added on to provider schedule without

permission Advanced practitioner appointment built into

schedule for daily add-on’s

Direct admission processMeeting on a regular basis w/inpatient leaders

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Recommended Treatment for Breast, Colorectal and Lung Cancers

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Making your EMR work for your practice

Focus is on proactively preventing side effects and toxicities

Labs & toxicity checks built into care plans

Antiemetics built into all regimens per NCCN guidelines

Growth factors built into appropriate care plans

Outpatient neutropenic protocol built by clinical pharmacistto avoid admissions for neutropenia

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Regimen build

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End of Life Care

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Palliative & end of life care

• QOPI End of life module• Palliative care team – collaboration between in and

outpatient• Continual education and discussions with providers• Nursing allowed to refer without initial discussion with

MD• Initiation of weekly palliative care conference

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Questions?

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