The Lynx Group

Models of Care Delivery Abstracts

April 2014, Vol 5, No 3

Implementation Strategies for Integrated Health System Nursing Specialty Group
Patricia E. Emerson, RN, MSN, OCN
Riverside Health System

This session will focus on the concepts found to be most essential to the success of building, and sustaining a healthcare system wide oncology nursing network. By highlighting our healthcare system’s quality commitment pillars, the framework uses people, integration, safety & quality, growth, and finance as guiding principles. This presenter will demonstrate how integration and collaboration has occurred as the result of monthly conference calls whereby subgroups report work being accomplished, and identify areas of opportunity representing all geographical locations within one health system. The Oncology Nursing Society’s values, mission, and commitment to the professional growth of oncology nurses has also served as a blueprint for the structured development of this team.

The Riverside Oncology Network is currently planning the third annual Oncology Nursing Conference, has reviewed and standardized all oncology nursing applicable policies and procedures, competencies, and orientation manuals, increased system wide Oncology Certified Nursing (OCN) percentile from 40% to 65% within two years, hosted educational dinner talks, developed a specialty group newsletter, and provided a collegial networking forum for the group to enhance standardization and core safety measures.

Quality & Cost Implications of Patient Navigation
Cheryl Gelder-Kogan, MHSA, Frederick M. Schnell, MD, FACP, Avery Winslett

Central Georgia Cancer Care, in partnership with the Cancer Clinics of Excellence (CCE), implemented a patient navigation program in order to improve the quality of life for its patients and to explore strategies that would simultaneously reduce the total cost of providing care to an oncology patient population. Early results demonstrate that a lay navigator is extremely effective in:

  • Helping patients maintain their proposed treatment regimens
  • Managing treatment associated symptoms
  • Avoiding trips to the emergency department
  • Minimizing inpatient hospitalizations
  • Educating the patient on the role of early palliative care, especially as a strategy to maintain a vigorous treatment schedule
  • Providing frequent care management interventions to identified high risk patients
  • Helping the patient understand available options when curative treatment is no longer feasible
  • Understanding and completing an advanced care directive, providing the patient and their loved ones with peace of mind
  • Helping to make the transition, when appropriate, to hospice care
  • Supporting and addressing the needs of caregivers
  • Providing needed emotional support for patients and caregivers
  • Finding financial, transportation and other resources to meet the needs of patients undergoing cancer treatment.
In response to the frustration on-call physicians have when patients experience symptoms after regular clinic hours, an “emergency” medication packet was developed. This emergency packet contains a very small supply of Ativan, Immodium, Dulcolax, Zofran and a prescription for Oxycontin. These drugs, which are frequently used by oncology patients but may not yet have been needed, enable the physicians to have the patient take something to address their symptoms—until they can be seen in the office the next day. Patients appreciate having something readily available, immediately at the time of need, and are grateful to avoid a trip to the emergency department.

Additionally, the navigation program has also explored strategies to ensure that all patient treatment regimens comply with nationally recognized and CCE approved treatment protocols and also monitors use of PET/CT scans, with an eye towards utilizing the lower cost test to answer the question being posed.

Early experience suggests that physicians benefit from having the navigator serve as “intermediary” and patient advocate. They appreciate that patients often feel more comfortable sharing details of their experiences with someone who is not directly “providing” their care.

The navigation program is tracking each intervention and estimating both the impact on quality for the patient and projecting total cost impact. The data generated from this program will be useful for other community based oncology programs looking to enhance the level of service provided to their patients and to payers that are addressing the total cost of care to high utilization and high cost oncology patients.

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