FALL NEWSCLiPs. An Update for Cancer Liaison Physicians from the Commission on Cancer of the American College of Surgeons

Transcription

1 An Update for Cancer Liaison Physicians from the Commission on Cancer of the American College of Surgeons

2 FALL 2015

3 Greetings Cancer Liaison Physicians, Welcome to the fall 2015 edition of NewsCLiPs. It contains valuable information to help you in your Cancer Liaison Physician (CLP) role, and I encourage you to read it carefully and to take time to visit the CoC website and become familiar with the many resources available to you. Please share your feedback with us at clp@facs.org. I hope you were able to attend the recent CoC and CLP meetings held during The American College of Surgeons Clinical Congress in Chicago. Dr. Ryan McCabe s update on the NCDB was most informative and will be a helpful resource. Dr. Richard Wender, chief cancer control officer with the American Cancer Society, presented on the national 80 percent by 2018 colorectal cancer screening initiative. The CLPs of the 1,500 accredited CoC programs have the opportunity to be the champions for this national effort with their local cancer programs and hospitals. I am encouraging all CLPs to focus on this colorectal screening initiative. Colorectal cancer is the number two cancer killer in the U.S., and we have the opportunity to dramatically change that statistic. Dr. Wender is the chair of the National Colorectal Roundtable, and his presentation contained many helpful tools for use by CLPs. There is also a wealth of information available on the National Colorectal Cancer Roundtable s website at nccrt. org. Please join in this national initiative. CLPs are the key to high-quality cancer programs. CLPs generously give their time and expertise in order to fulfill the mission of the Commission on Cancer in improving survival and quality of life for cancer patients. At the recent CLP Breakfast, Dr. Daniel McKellar and Dr. David Winchester made a presentation to thank all CLPs for their service and dedication. They also gave special recognition to the CLPs that have served multiple terms. I wish to also extend a thank you to all CLPs for their dedication and hard work. Your efforts are deeply appreciated.

4 Best wishes, and please keep in touch. The Cancer Liaison Physician Committee values your input. Plans are beginning for the coming year, and if there are topics you would like to see covered please let me know. Mary Milroy Mary J. Milroy, MD, FACS Chair, Committee on Cancer Liaison

5 State Chair Comments

6 CoC Quality Corner Getting Started with Quality Improvement Ted A. James, MD, MS, FACS Our State Chairs and CLPs provide an important service leading cancer patient care and helping to promote performance improvement in clinical oncology locally, regionally, and nationally. Quality improvement is a major component of your responsibilities, and having a framework for your quality improvement initiatives can directly impact the likelihood of success versus failure. Starting off on the right foot is critical. In addition to having a strong problem statement and aim statement, there is a simple algorithm to help you get started: FOCUS ÂÂ Find the opportunity ÂÂ Organize the team ÂÂ Clarify the current process ÂÂ Understand the problem(s) ÂÂ Select the intervention(s) Find the opportunity Given the inherent complexity and growing demands of cancer care, there is an abundance of opportunity to improve systems of care. Professional organizations focused on health care quality improvement (QI) have provided priority areas to concentrate QI initiatives. The Institute for Health Care Improvement triple aim describes an approach to optimizing health system performance by (1) improving population health, (2) improving the experience of care, and (3) lowering the cost of care. QI efforts should look to address these concerns. The National Academy of Medicine (formally the

7 Institute of Medicine) has outlined six specific aims that health care systems should strive to fulfill in order to deliver quality care: safe, effective, efficient, equitable, timely, and patient-centered. These aims provide another framework to identify areas where cancer programs can improve. This area is also where the National Cancer Data Base (NCDB) benchmark reports and tools (for example, the Rapid Quality Reporting System) can come into play. These quality metrics can be used to compare cancer programs with others as well as with national standards. Cancer leaders can use NCDB tools to identify areas that are underperforming, implement QI plans, and monitor performance. Organize the team Quality improvement is a team venture. Meaningful and sustainable improvements in system-based care rarely arise from individual efforts alone. Ideally, the QI team should include, at minimum, a system leader (for example, clinic manager or administrative director), subject matter experts (for example, physicians, nurses), front line workers (for example, clinic staff, medical assistants) and executive support (for example, cancer center director or department chair). Assembling the appropriate team will allow individuals to combine their unique knowledge and skills to bring about lasting improvements. QI teams should meet regularly, utilize effective group process techniques, identify a champion to lead, and use best practices in teamwork to move toward a common, well-articulated goal. Clarify the current process. It is essential to understand the system that you are attempting to improve, as illustrated in the quote attributed to Albert Einstein, If I were given one hour to save the planet, I would spend 59 minutes defining the problem and one minute resolving it. Take the time to develop an in-depth knowledge of the system and understanding of the process. Doing so will allow you and your team to ask the right questions and solve the right problem. Process mapping is an example of a QI tool that helps to define the reality of the current process. The process map allows team members to visualize opportunities for improvement. Ideally, when process mapping, observations should be made over different days and times to capture important variations in the flow of the process. Also, it is helpful to post completed process maps in the work area and invite input from the staff working in the process. Incorporate their feedback. Obtaining baseline data about the current process is also critical. Without data it will be impossible to know where you stand or whether or not an intervention has made any difference.

8 The data can be obtained from a variety of sources, including clinical databases, surveys, chart reviews, interviews, and contextual observations. Meaningful quality improvement must be datadriven. Understand the problem(s) Defining the specific areas where the process fails or underperforms is another key step in the QI framework. The root causes behind a deficiency should be explored and comprehended. The Fishbone (Cause-and-Effect or Ishikawa) Diagram is a QI tool used to identify as many possible causes for an effect or problem and sorts them into useful categories. This tool can be combined with a brainstorming session to identify and classify factors hindering quality. Another QI tool is the Pareto chart, a bar graph that visually depicts which factors represent the vital few versus the trivial many. The principle of the Pareto chart is that 80 percent of the problem is typically caused by only 20 percent of factors. This step is also the opportunity to undercover any variation within the current process. Dynamic displays of data over time will allow the team to glean more from the data and make accurate interpretations and decisions regarding the underlying variation. It is important to distinguish between variation due to common causes and variation due to special causes, because the appropriate action for process improvement depends on what type of variation is present. In general, special cause variation leading to poor performance should be isolated or eliminated, whereas common cause variation resulting in poor performance requires the entire system to change. Select the intervention(s) Once the process has been clearly understood, the problem has been well-defined, and the baseline data collected, then the intervention(s) can be selected for implementation. QI tools such as a Priority Matrix Chart can be used to categorize list of interventions by priority, pay-off, and feasibility. The team will determine what specific solution to test and create a goal for the improvement. At this point, any one or combination of QI methodologies (for example, PDSA, Lean) can be put into place.

9 Summary This article outlined an example of a practical QI system. No particular framework is necessarily superior to any other, but having a framework to launch QI efforts is like having a road map before starting a long journey. One of the biggest mistakes in QI is to jump into a change initiative without a clear FOCUS. Additional Resources ÂÂ The 7 Basic Quality Tools for Process Improvement: American Society for Quality ÂÂ Institute for Healthcare Improvement

10 Cancer Liaison Physician Breakfast Highlights Shortly after the coffee was poured for the Cancer Liaison Physician breakfast, Ryan McCabe, Senior Manager of the National Cancer Data Base (NCDB), presented a brief overview of NCDB tools relevant for CLPs to drive quality improvement at their local cancer program. The presentation included the purpose and definitions of quality measures Accountability, Quality Improvement, and Surveillance. Accountability measures have the highest level of clinical evidence and hold programs to the highest threshold of performance (usually 90 percent) for accreditation. Even so, CLPs were reminded that 100 percent compliance with any measure is not expected for compliance with quality measures. Additionally, brief overviews of the types of things that can be done with CP3R, CQIP, and RQRS were highlighted. The Cancer Program Practice Profile Report (CP3R), Cancer Quality Improvement Program (CQIP), and the Rapid Quality Reporting System (RQRS) are all data-driven quality improvement tools to support CLPs in a range of quality improvement efforts from verifying increased performance following local practice changes to identifying areas of performance gaps that could be analyzed and addressed for improving care for the cancer patient. Participant User Files (PUF) were also discussed as de-identified research files that are made available twice a year (July/January) to researchers who are affiliated with CoC-accredited institutions. Finally, the NCDB is preparing more education, collaboration, and networking opportunities for CLPs and others at our annual NCDB Workshop as part of the CoC Annual Conference (formerly Survey Savvy) that will take place in Chicago, IL, June 1 3, We hope to see you all here in Chicago next June! Check the CoC Source for details. You can now access the CLP breakfast recording on our website at cancer/clp/news

11 The American Cancer Society Thanks You The American Cancer Society would like to thank Cancer Liaison Physicians for your contributions to CoC cancer programs across the country. In addition to your leadership on the Cancer Committee, a number of Cancer Liaison Physicians have made a significant impact on the collaboration between the American Cancer Society and their cancer program. A few examples from across the country are included below. Dr. Richard Capone with St. Rita s Health Partners in Lima, OH, truly embodies the role of CLP and working with the American Cancer Society (ACS). He is an active leader of the Cancer Committee and is chair of the Northwest Ohio Colorectal Cancer Awareness Coalition. Dr. Capone is a member of the ACS Allen County Volunteer Leadership Council and is a supporter of Relay For Life. Dr. Capone provides education about colon cancer to Relay for Life attendees while standing with a Super Colon at the event. Dr. Capone is an exemplary CLP, which can also be illustrated by St Rita s multiple outstanding achievement recognitions from CoC surveys while he has been in this role. Andrew Mariani, Health Systems Manager, East Central Division

12 Dr. Matthew Koshy has played an integral role expanding the partnership between the UI Cancer Center and the American Cancer Society. Within six months of working together, we established a Collaboration Action Plan, recruited the entire Cancer Committee to join as ACS CAN members, and increased referral rates of newly diagnosed patients to ACS from 38 percent in 2014 to 76 percent in His collaboration and efforts with American Cancer Society have been outstanding and are greatly appreciated. Jessica Smith, Health Systems Manager, Lakeshore Division Dr. Ellen Mahoney with St. Joseph Hospital in Eureka, KS, is a strong advocate for the American Cancer Society (ACS). Dr. Mahoney participates on the St. Joseph team at Relay For Life and has given a presentation to participants in the Survivor Tent at the event for the last two years. Dr. Mahoney has also acted as door opener for ACS with other local clinics when we need assistance getting in front of appropriate people. Cathleen Zoller, Health Systems Manager, California Division I work closely with Dr. Christine Van Cott, CLP at St. Vincent s Medical Center in Bridgeport, CT. Dr. Cott is being honored for her support of American Cancer Society s Women Leading the Way to Wellness Event. She is a member of our colorectal roundtable planning committee and will be presenting at the CRC roundtable conference on the High Risk Assessment Team in place at St. Vincent s. John Watkins, Health Systems Manager, New England Division

13 I wanted to share with you a great success working with Dr. Andrew Weil, CLP of the UNC Affiliated Nash Healthcare System in Rocky Mount, NC. In Nash Healthcare s last survey, the surveyor recommended that they take a more customized and strategic approach to Standards 4.1 and 4.2. In early 2015, I met with Dr. Weil and the cancer program director, Chris Woods, to discuss how we could collaborate on these standards. Many great things happened from this meeting: ÂÂ Nash Healthcare System signed the 80 percent by 2018 pledge and has made colorectal screening a priority within the cancer program. ÂÂ The cancer committee has identified local health departments, community health centers, and large neighboring Healthcare Systems to partner with them in addressing colorectal cancer screening rates. ÂÂ Dr. Weil joined in one of our internal ACS staff team meetings to share his personal commitment to fighting colorectal cancer, equating it to the HPV epidemic years ago and sharing insights into making it work in whatever way we can. Rachel Urban, Health Systems Manager, South Atlantic Division Dr. Keith Nichols with OhioHealth s Riverside Methodist Hospital is an asset to their cancer committee as their CLP. He continually comes prepared with his quarterly CLP report and is avid about discussions on topics surrounding updates, needs, and solutions within their system and how the American Cancer Society can assist. Amy Magorien, Health Systems Manager, East Central Division

14 OVCT: Ovarian Measure Will Not Be Included in CQIP 2015 The National Cancer Data Base (NCDB) has identified an issue with the OVCT Ovarian Quality of Care Measure recently implemented in CP3R: Chemotherapy started within 42 days (before or after) the Date of Most Definitive Surgery in Stages IA-IV Ovarian, Fallopian Tube, or Peritoneal Cancers. This measure currently monitors administration of both neoadjuvant and adjuvant chemotherapy. However, the intent of the measure is to monitor the administration of adjuvant chemotherapy only, within 42 days after surgery. The NCDB will be updating the measure specifications to remove eligibility criteria for cases receiving neoadjuvant therapy, and the measure will be updated in CP3R in the near future. As a result, the OVCT measure WILL NOT BE INCLUDED IN CQIP Registrars should utilize the remaining time available for corrections in CP3R to review the remaining measures. Please note that all of the new measures that were implemented in September are for surveillance purposes only and will not be assessed upon survey. We apologize for any inconvenience this issue may have caused. The NCDB would like to thank all of the hospital registrars that contributed to the identification of this issue by contacting us with their concerns. We are all working together to improve patient outcomes, and without the commitment demonstrated by hospital registrars we would not be able to continually evolve and meet this goal.

15 New Cancer Surgery Manual Available from the American College of Surgeons and Alliance for Clinical Trials in Oncology The American College of Surgeons and the Alliance for Clinical Trials in Oncology present the first comprehensive, evidence-based examination of cancer surgery techniques that are critical to achieve optimal outcomes in a cancer operation. The first volume of this unique manual focuses on best practices for breast, colon, lung, and pancreatic surgery, describing the surgical procedures that occur between skin incision and skin closure that directly affect cancer outcomes. Order your copy today.

16 January 1, 2016, Expiring CLP Terms CLPs serve a three-year term and are eligible to serve an unlimited number of terms based on performance and evaluation data collected at the time of survey. More than 100 CLP terms will expire on January 1, 2016, and each cancer committee must determine whether their current CLP is appropriately serving in this role or if another candidate would better suit the position. An notification and instructions will be sent to cancer committee chairs of programs with a CLP whose term is expiring. The CLP and cancer registrars will be notified as well. The facility must either reappoint the CLP for another three-year term or recommend a replacement to fill the role. At this time, please make sure your CLP has completed the CLP Activity Report located in your Survey Application Record (SAR) if it is the year of survey or your Pre-Survey Application Record (PAR) if it is not. Please update and confirm your CLP s contact information in CoC Datalinks. If you have questions or concerns, please us at clp@facs.org. Note: If your accredited facility does not have a CLP in place, you are in jeopardy of noncompliance with CoC Standards 1.3 and 4.3. It is important that you make an appointment as soon as possible and that you designate an individual as the CLP in CoC Datalinks. If a CLP is not appointed for your facility and recorded in CoC Datalinks, the CoC recommends that the cancer committee chair be listed as the interim CLP until an official appointment is made.

17 Have You Seen the New Standards Resource Library? The Best Practice Repository and Resource Repository have merged into the new and improved Standards Resource Library. You will find the new library housed on the CAnswer Forum home page. The CAnswer Forum is a central location for our constituents to review previously asked and answered questions about the standards; submit new questions on a standard, and view examples and resources to help guide programs in meeting the standards. The CoC is developing, reviewing, and posting quality examples and resources to the new library. As potential documents and resources are identified from cancer programs and Survey Application Records, they are sent to the Resource Review Group. This group consists of 12 CoC Surveyors who review each example to ensure that it meets the standard, is clear and concise, and is easily adaptable for use by other programs. If you are currently a registered user of the CAnswer Forum, log on and check out the new Standards Resource Library. If you are not a registered user of the CAnswer Forum, please send a request to Accreditation@ facs.org to obtain a user name and password. You will need to register to obtain access to both the forum and the Standards Resource Library.

18 The CoC and the NAPBC are going social Follow the CoC and the NAPBC on Twitter. Make sure you also like the NAPBC Facebook page.

19 Don t Forget to let us know how we can support you in your CLP role. to let us know when your address has changed so we can keep our records up to date and you won t miss any important communications. to share your best practices on data reporting by ing us at clp@facs.org.

20 We Want to Hear From You What topics do you want to see in the next issue of NewsCLiPs? Let us know at Do you have an article you d like to submit to us for NewsCLiPs? Let us know at clp@facs.org

21 Cancer Liaison Initiatives Staff Nina Miller Manager Carolyn Jones Coordinator Fax: