Implementing Cancer Survivorship Care Planning Workshop Summary (2007) / Chapter Skim
Currently Skimming:
5 Pilot Tests and Assessment of Their Impact
5 Pilot Tests and Assessment of Their Impact
Pages 107-128
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From page 107... ...
could potentially play to improve survivorship care is then discussed by Patricia Ganz. Martin Brown illustrates the potential for research networks to promote applied survivorship research with the success of the National Cancer Institute's HMO Cancer Research Network in carrying out cancerrelated health services research.
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From page 108... ...
These centers will be involved in the following activities: · Collaborative clinical, biomedical, psychosocial, and health services research; · Accessible, relevant, and integrated quality care and services; · Development and testing of new medical, psychosocial, and behavioral interventions; · Dissemination and delivery of new information, interventions, and best practices to those in need; and · Training the next generation of health care professionals, social service providers, and researchers. Each center of excellence will develop its own network of communitybased centers, which will provide direct services locally to survivors in traditionally underserved areas.
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From page 109... ...
This collaboration is expected to accelerate the progress in cancer survivorship. The development of a standardized Survivorship Care Plan is one of the priorities of the network.
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From page 110... ...
The Dana-Farber Center of Excellence is affiliated with a rural oncology practice in New Hampshire and is collaborating with an urban community health center and centers in New England that deliver pediatric cancer care. Specialists in the center will be working with community-based primary care physicians, pediatricians, and pediatric oncologists to raise awareness of survivorship issues and how to address them.
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From page 111... ...
Earle reported that, although they were not using the Lance Armstrong LIVESTRONG notebook, they are incorporating all of its elements in structured letters to patients that include the treatment plan, the treatment summary, and the survivorship care plan. Structured consultation notes are sent to the primary care providers and the oncologists involved.
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From page 112... ...
With the publication of the Institute of Medicine (IOM) report on cancer survivorship, it became clear that survivorship care planning depends on having accurate and accessible diagnostic and treatment information.
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From page 113... ...
Physician and nurse buy-in is a prerequisite to success. Ultimately, the design of the template has to be adapted for electronic medical records.
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From page 114... ...
He pointed out that pilot tests are under way to assess usability and feasibility, but in the long term he thought that these care plans must be evaluated for their effects on important survivorship outcomes. Such evidence will be needed to persuade payers and others that survivorship care planning is an essential component of care.
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From page 115... ...
The network is ideally suited for pilot testing a treatment summary and care plan, because the researchers in this network have access to health care systems that will provide care to 15 million individuals by 2007. There were 37,503 incident cancers in the network in 2003.
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From page 116... ...
The CRN also allows assessments of the costs associated with interventions and with utilization. This is a unique platform to ask some of the very questions that have been raised during the workshop about the role of care plans and their potential benefits for patients and their families, payers, and society.
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From page 117... ...
There is also a program announcement on the use of health claims data for health services research. This has been used primarily to fund research using the SEER-Medicare database, which is maintained by NCI, but it could also be used for analyses of other types of health claims THE CENTERS FOR MEDICARE AND MEDICAID SERVICE'S 2006 ONCOLOGY DEMONSTRATION PROGRAM Presenter: Dr.
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From page 118... ...
Physicians use E&M codes for doctor-patient interactions when the focus is on problems and care planning. This shift in emphasis also removed the incentive for intravenous treatments in place of alternative therapeutic choices, such as oral chemotherapy.
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From page 119... ...
M1, Metastatic , Locally recurrent, Progressive FIGURE 5-2 Colon cancer disease status codes.
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From page 120... ...
Included in the NCCN guidelines, for example, is that stage III colon cancer patients after surgery should be offered adjuvant chemotherapy. This demonstration will help CMS learn whether asking about guideline adherence is an effective way to measure quality of care.
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From page 121... ...
To determine the proportion of patients for whom appropriate care is provided, a rate is assembled with a numerator and a denominator. The denominator includes patients with an ICD-9 code for colon cancer as well as the disease status code indicating stage III cancer.
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From page 122... ...
James Talcott began the discussion by raising a concern about basing the oncology demonstration on guidelines that are both evidence based and based on expert opinion. There is sometimes a blurring of the distinction between these two types of guidelines.
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From page 123... ...
Dr. Bach pointed out that the focus of the visit coding used in the 2006 demonstration has not broken out survivorship care planning.
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From page 124... ...
In the IOM report there is a strong recommendation for action and also a charge going out to the research community to accumulate the evidence surrounding use of survivorship care planning. Creating survivorship care plans is time-consuming and requires work from busy clinicians.
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From page 125... ...
Evaluating how survivorship care planning affects anxiety or depression is critically important, because while such planning is likely to address these issues for most patients, it may increase anxiety or depression for others. Implementing parts of the Survivorship Care Plan may assist in identifying late effects of cancer treatment, and if interventions are available there is the possibility of relieving symptoms and improving quality of life, functional status, and survival.
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From page 126... ...
Demonstrations are needed to evaluate whether the responsibility for care planning should rest primarily with the oncology specialist, perhaps in conjunction with a nurse practitioner, a team in a dedicated survivorship clinic, or through a shared care model between the oncology and primary care provider. The optimal care delivery model will be likely to vary according to patient preference and circumstance.
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From page 127... ...
If randomization occurs at the level of a patient, a physician who is providing care planning to some patients and not to others is probably going to improve the survivorship care planning that they do with all patients. Because the IOM and other groups have recommended survivorship care planning, there may also be ethical issues if some patients are randomized to a group that does not receive care plans.
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From page 128... ...
In conclusion, rigorous systematic studies are necessary in order to determine what works and what does not work in survivorship care planning. The IOM report called for increased support for research and demonstration projects.
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