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Tracking Clinical Pathways Through An Electronic Dashboard Improves Efficiency of Cancer Care
Purpose/Rationale: The purpose of this quality improvement project was three- fold; (1) To develop a cancer tracking dashboard that would replace a cumbersome and outdated paper-driven process; (2) To improve the cycle time to initiate treatment by one week; and (3) To decrease clinical time spent reviewing patient charts for timeliness.
Background: Bay Pines VA Healthcare System (BPVAHCS) established a Cancer Care Navigation Program (CCNP), specific to the head and neck cancer patient population. The nurse navigator is responsible for facilitating the Veteran’s progress through a complex healthcare system. The Veterans Health Administration system does not have one specific standard instrument to track the veteran across the cancer care continuum.
Methods: This project was limited to head and neck cancer cases who were to receive concurrent chemotherapy and radiation. Exclusions included surgical cases, adjuvant chemotherapy and/or radiation, and patients receiving care through the community. The cycle time is defined as: time pathology is signed to initiation of treatment. A retrospective chart review was conducted to calculate the cycle time for two fiscal quarters prior to implementation of the tool. We also documented daily the amount of time spent by the nurse in the Computerized Patient Record System (CPRS) to coordinate seamless cancer care. The data were then entered into an excel spread sheet and analyzed. As a result, this systems redesign project, an electronic tracking dashboard was designed and implemented. The exact data were extrapolated using the tool for the next two fiscal quarters.
Results: The quantitative data was a comparison of two samples; two quarters prior/after two quarters after implementation of the dashboard. The two sample unpaired t-test was utilized for analysis. Group one (n = 22) and group two (n = 23), the P value is < .0001 by conventional criteria; this difference is considered to be extremely statistically significant.
Conclusions/Implications: Utilizing the dashboard has rendered an additional 115 nursing hours dedicated to direct patient care and has improved by timeliness to treatment by five days. Current work includes building the dashboard to represent most cancers and the integration of the cancer tracking dashboard with CPRS enabling data to auto populate.
Purpose/Rationale: The purpose of this quality improvement project was three- fold; (1) To develop a cancer tracking dashboard that would replace a cumbersome and outdated paper-driven process; (2) To improve the cycle time to initiate treatment by one week; and (3) To decrease clinical time spent reviewing patient charts for timeliness.
Background: Bay Pines VA Healthcare System (BPVAHCS) established a Cancer Care Navigation Program (CCNP), specific to the head and neck cancer patient population. The nurse navigator is responsible for facilitating the Veteran’s progress through a complex healthcare system. The Veterans Health Administration system does not have one specific standard instrument to track the veteran across the cancer care continuum.
Methods: This project was limited to head and neck cancer cases who were to receive concurrent chemotherapy and radiation. Exclusions included surgical cases, adjuvant chemotherapy and/or radiation, and patients receiving care through the community. The cycle time is defined as: time pathology is signed to initiation of treatment. A retrospective chart review was conducted to calculate the cycle time for two fiscal quarters prior to implementation of the tool. We also documented daily the amount of time spent by the nurse in the Computerized Patient Record System (CPRS) to coordinate seamless cancer care. The data were then entered into an excel spread sheet and analyzed. As a result, this systems redesign project, an electronic tracking dashboard was designed and implemented. The exact data were extrapolated using the tool for the next two fiscal quarters.
Results: The quantitative data was a comparison of two samples; two quarters prior/after two quarters after implementation of the dashboard. The two sample unpaired t-test was utilized for analysis. Group one (n = 22) and group two (n = 23), the P value is < .0001 by conventional criteria; this difference is considered to be extremely statistically significant.
Conclusions/Implications: Utilizing the dashboard has rendered an additional 115 nursing hours dedicated to direct patient care and has improved by timeliness to treatment by five days. Current work includes building the dashboard to represent most cancers and the integration of the cancer tracking dashboard with CPRS enabling data to auto populate.
Purpose/Rationale: The purpose of this quality improvement project was three- fold; (1) To develop a cancer tracking dashboard that would replace a cumbersome and outdated paper-driven process; (2) To improve the cycle time to initiate treatment by one week; and (3) To decrease clinical time spent reviewing patient charts for timeliness.
Background: Bay Pines VA Healthcare System (BPVAHCS) established a Cancer Care Navigation Program (CCNP), specific to the head and neck cancer patient population. The nurse navigator is responsible for facilitating the Veteran’s progress through a complex healthcare system. The Veterans Health Administration system does not have one specific standard instrument to track the veteran across the cancer care continuum.
Methods: This project was limited to head and neck cancer cases who were to receive concurrent chemotherapy and radiation. Exclusions included surgical cases, adjuvant chemotherapy and/or radiation, and patients receiving care through the community. The cycle time is defined as: time pathology is signed to initiation of treatment. A retrospective chart review was conducted to calculate the cycle time for two fiscal quarters prior to implementation of the tool. We also documented daily the amount of time spent by the nurse in the Computerized Patient Record System (CPRS) to coordinate seamless cancer care. The data were then entered into an excel spread sheet and analyzed. As a result, this systems redesign project, an electronic tracking dashboard was designed and implemented. The exact data were extrapolated using the tool for the next two fiscal quarters.
Results: The quantitative data was a comparison of two samples; two quarters prior/after two quarters after implementation of the dashboard. The two sample unpaired t-test was utilized for analysis. Group one (n = 22) and group two (n = 23), the P value is < .0001 by conventional criteria; this difference is considered to be extremely statistically significant.
Conclusions/Implications: Utilizing the dashboard has rendered an additional 115 nursing hours dedicated to direct patient care and has improved by timeliness to treatment by five days. Current work includes building the dashboard to represent most cancers and the integration of the cancer tracking dashboard with CPRS enabling data to auto populate.
Patient Navigation Program (PNP) Improves Veteran Head and Neck (HAN) Cancer Program
Background: Head and neck (HAN) cancer is diagnosed in more than 50,000 Americans annually and is the third most common malignancy in the Veteran patient population. There are > 185,000 American HAN cancer survivors. The comprehensive nature of this disease causes challenges from diagnosis through survivorship. A lack of patient navigation program (PNP) for patients with HAN cancer often lead to fragmented care, delay in initiation of treatment, increased healthcare cost, poor cancer outcome, and a decrease in patient satisfaction.
Purpose: To improve care outcomes among patients with HAN cancer through the implementation of the PNP. Specifically, the program is targeted towards providing holistic patient-centered care, eliminating fragmented care and delays, and decreasing emotional distress and healthcare cost.
Method: In the First Phase, we conducted a need assessment for the PNP. In the Second Phase, we implemented the PNP in 2015 using current evidence and Deming’s (1993) Plan-Do-Study-Act (PDSA) model. During the Implementation Phase of the PNP, we developed a clinical algorithm and order set. We also strengthened our partnership with Non-VA Care Coordination
to expedite community care.
Outcomes: The PNP has served 140 Veterans with well over 500 clinical visits. Consistent with our expectation, the program has resulted in improved oncology infrastructure and timeliness of care. For instance, before the program, there was an average of 16 weeks from suspicion to initiation of treatment. After PNP implementation, the process now takes 4 to 6 weeks. The PNP has eliminated repeat computerized axial tomography, and thus, decreasing healthcare cost by $262,500 annually. Besides its economic impact, the PNP has also led to improved patient and provider satisfaction.
Clinical Implications: Overall, the PNP is a robust patientcentered care program which provides holistic care to patients from cancer suspicion to treatment initiation. Although the PNP continues to evolve, its implementation in BPVAHCS has had a significant impact in the care of HAN cancer patients. Due to the success of the current PNP, BPVAHCS is planning to include all cancer sites by 2020.
Background: Head and neck (HAN) cancer is diagnosed in more than 50,000 Americans annually and is the third most common malignancy in the Veteran patient population. There are > 185,000 American HAN cancer survivors. The comprehensive nature of this disease causes challenges from diagnosis through survivorship. A lack of patient navigation program (PNP) for patients with HAN cancer often lead to fragmented care, delay in initiation of treatment, increased healthcare cost, poor cancer outcome, and a decrease in patient satisfaction.
Purpose: To improve care outcomes among patients with HAN cancer through the implementation of the PNP. Specifically, the program is targeted towards providing holistic patient-centered care, eliminating fragmented care and delays, and decreasing emotional distress and healthcare cost.
Method: In the First Phase, we conducted a need assessment for the PNP. In the Second Phase, we implemented the PNP in 2015 using current evidence and Deming’s (1993) Plan-Do-Study-Act (PDSA) model. During the Implementation Phase of the PNP, we developed a clinical algorithm and order set. We also strengthened our partnership with Non-VA Care Coordination
to expedite community care.
Outcomes: The PNP has served 140 Veterans with well over 500 clinical visits. Consistent with our expectation, the program has resulted in improved oncology infrastructure and timeliness of care. For instance, before the program, there was an average of 16 weeks from suspicion to initiation of treatment. After PNP implementation, the process now takes 4 to 6 weeks. The PNP has eliminated repeat computerized axial tomography, and thus, decreasing healthcare cost by $262,500 annually. Besides its economic impact, the PNP has also led to improved patient and provider satisfaction.
Clinical Implications: Overall, the PNP is a robust patientcentered care program which provides holistic care to patients from cancer suspicion to treatment initiation. Although the PNP continues to evolve, its implementation in BPVAHCS has had a significant impact in the care of HAN cancer patients. Due to the success of the current PNP, BPVAHCS is planning to include all cancer sites by 2020.
Background: Head and neck (HAN) cancer is diagnosed in more than 50,000 Americans annually and is the third most common malignancy in the Veteran patient population. There are > 185,000 American HAN cancer survivors. The comprehensive nature of this disease causes challenges from diagnosis through survivorship. A lack of patient navigation program (PNP) for patients with HAN cancer often lead to fragmented care, delay in initiation of treatment, increased healthcare cost, poor cancer outcome, and a decrease in patient satisfaction.
Purpose: To improve care outcomes among patients with HAN cancer through the implementation of the PNP. Specifically, the program is targeted towards providing holistic patient-centered care, eliminating fragmented care and delays, and decreasing emotional distress and healthcare cost.
Method: In the First Phase, we conducted a need assessment for the PNP. In the Second Phase, we implemented the PNP in 2015 using current evidence and Deming’s (1993) Plan-Do-Study-Act (PDSA) model. During the Implementation Phase of the PNP, we developed a clinical algorithm and order set. We also strengthened our partnership with Non-VA Care Coordination
to expedite community care.
Outcomes: The PNP has served 140 Veterans with well over 500 clinical visits. Consistent with our expectation, the program has resulted in improved oncology infrastructure and timeliness of care. For instance, before the program, there was an average of 16 weeks from suspicion to initiation of treatment. After PNP implementation, the process now takes 4 to 6 weeks. The PNP has eliminated repeat computerized axial tomography, and thus, decreasing healthcare cost by $262,500 annually. Besides its economic impact, the PNP has also led to improved patient and provider satisfaction.
Clinical Implications: Overall, the PNP is a robust patientcentered care program which provides holistic care to patients from cancer suspicion to treatment initiation. Although the PNP continues to evolve, its implementation in BPVAHCS has had a significant impact in the care of HAN cancer patients. Due to the success of the current PNP, BPVAHCS is planning to include all cancer sites by 2020.