Schwartz J

Background: Prostate cancer is the second most common cancer in men. The American Cancer Society estimated about 164,690 new cases of prostate cancer in 2018. Since opening its doors in 1932, the New Mexico VA Healthcare System (NMVAHCS) had not held a prostate cancer support group. A review of the literature suggests that older prostate cancer patients benefit from the continuous social support in face-toface support groups. In light of the American Cancer Society estimates and the predominately male population served at the NMVAHCS, of which nearly 1300 of these veterans are living with prostate cancer, the need for a support group warranted investigation.

Methods: A needs assessment was completed with 50 veterans diagnosed with prostate and receiving care in the Urology Section of the New Mexico VA Healthcare System. This assessment included a 3 question survey aimed at determining veteran awareness of the Albuquerque community prostate cancer support group, attendance at this support group and lastly if they would attend a veteran centered prostate cancer support group on the NMVAHCS campus.

Results: Of the 50 veterans surveyed, 40% were aware of the community based prostate cancer support group while 12% had actually attended a meeting. 60% of the respondents stated that they would attend a veterans-centered prostate cancer support group on the NMVAHCS campus. 50% of those who responded that they would not attend a meeting stated that they lived too far away from the main campus but would attend via a telehealth meeting at their local community based outpatient clinic (CBOC).

Conclusion: Based on the survey findings, the decision was made to launch a Veteran Center Prostate Cancer Support Group. Men Talking to Men about Prostate Cancer held its inaugural meeting June 6, 2018 and has continued to meet bi-monthly. Sessions are facilitated by the New Mexico Prostate Cancer Support Association and include a multidisciplinary presentation of issues common to the veteran prostate cancer patient as well as a physician led question and answer session.

Background: Prostate cancer is the second most common cancer in men. The American Cancer Society estimated about 164,690 new cases of prostate cancer in 2018. Since opening its doors in 1932, the New Mexico VA Healthcare System (NMVAHCS) had not held a prostate cancer support group. A review of the literature suggests that older prostate cancer patients benefit from the continuous social support in face-toface support groups. In light of the American Cancer Society estimates and the predominately male population served at the NMVAHCS, of which nearly 1300 of these veterans are living with prostate cancer, the need for a support group warranted investigation.

Methods: A needs assessment was completed with 50 veterans diagnosed with prostate and receiving care in the Urology Section of the New Mexico VA Healthcare System. This assessment included a 3 question survey aimed at determining veteran awareness of the Albuquerque community prostate cancer support group, attendance at this support group and lastly if they would attend a veteran centered prostate cancer support group on the NMVAHCS campus.

Results: Of the 50 veterans surveyed, 40% were aware of the community based prostate cancer support group while 12% had actually attended a meeting. 60% of the respondents stated that they would attend a veterans-centered prostate cancer support group on the NMVAHCS campus. 50% of those who responded that they would not attend a meeting stated that they lived too far away from the main campus but would attend via a telehealth meeting at their local community based outpatient clinic (CBOC).

Conclusion: Based on the survey findings, the decision was made to launch a Veteran Center Prostate Cancer Support Group. Men Talking to Men about Prostate Cancer held its inaugural meeting June 6, 2018 and has continued to meet bi-monthly. Sessions are facilitated by the New Mexico Prostate Cancer Support Association and include a multidisciplinary presentation of issues common to the veteran prostate cancer patient as well as a physician led question and answer session.

Background: Prostate cancer is the second most common cancer in men. The American Cancer Society estimated about 164,690 new cases of prostate cancer in 2018. Since opening its doors in 1932, the New Mexico VA Healthcare System (NMVAHCS) had not held a prostate cancer support group. A review of the literature suggests that older prostate cancer patients benefit from the continuous social support in face-toface support groups. In light of the American Cancer Society estimates and the predominately male population served at the NMVAHCS, of which nearly 1300 of these veterans are living with prostate cancer, the need for a support group warranted investigation.

Methods: A needs assessment was completed with 50 veterans diagnosed with prostate and receiving care in the Urology Section of the New Mexico VA Healthcare System. This assessment included a 3 question survey aimed at determining veteran awareness of the Albuquerque community prostate cancer support group, attendance at this support group and lastly if they would attend a veteran centered prostate cancer support group on the NMVAHCS campus.

Results: Of the 50 veterans surveyed, 40% were aware of the community based prostate cancer support group while 12% had actually attended a meeting. 60% of the respondents stated that they would attend a veterans-centered prostate cancer support group on the NMVAHCS campus. 50% of those who responded that they would not attend a meeting stated that they lived too far away from the main campus but would attend via a telehealth meeting at their local community based outpatient clinic (CBOC).

Conclusion: Based on the survey findings, the decision was made to launch a Veteran Center Prostate Cancer Support Group. Men Talking to Men about Prostate Cancer held its inaugural meeting June 6, 2018 and has continued to meet bi-monthly. Sessions are facilitated by the New Mexico Prostate Cancer Support Association and include a multidisciplinary presentation of issues common to the veteran prostate cancer patient as well as a physician led question and answer session.

Purpose: To improve breast cancer care and support services to the growing population of younger female Veterans diagnosed with breast cancer. To develop partnerships with non-profit community resources to meet specif c needs and increase resources for all patients living with a breast cancer diagnosis.

Background: Historically, the New Mexico Veterans Affairs Healthcare System (NMVAHCS) has provided care to a predominately male population. However, this demographic is evolving significantly due to an increased number of women serving during Operation Iraqi Freedom and Operation Enduring Freedom conflicts and with improved detection women are being diagnosed younger. Younger women diagnosed with breast cancer experience unique concerns and providers often neglect or avoid discussions involving these difficult topics.

Methods: We utilized grant funding through Living Beyond Breast Cancer (LBBC) to provide education and outreach support specific for younger women diagnosed before 45 years of age. The Surgical Cancer Care Coordinator attended training and was provided educational slide content, handouts, and media templates to promote on-site educational seminars. Four sessions were held: sex and intimacy, early menopause, late complications, and the role of genetics. Telehealth allowed women in rural sections of the state to participate.

Results: Pre and post-surveys were conducted at each session. Pre-survey results: 10% of attendees reported providers initiated sexual function conversations and 5% stated providers seemed comfortable answering questions regarding sexual function Postsurvey results: 100% of attendees felt empowered with knowledge and resources to improve intimacy and sexual relations with their partners. All 4 sessions provided information on topics not previously discussed and developed camaraderie support.

Conclusion: Educating and encouraging young women to discuss symptoms with their providers remains essential. While the VAHCS begins to increase access to women’s health, facilities can develop community partnerships to support unmet needs. Partnering with LBBC Young Women’s Initiative is an example of improving survivorship care without impacting facility budgets or experiencing bureaucratic constraints.

Purpose: To improve breast cancer care and support services to the growing population of younger female Veterans diagnosed with breast cancer. To develop partnerships with non-profit community resources to meet specif c needs and increase resources for all patients living with a breast cancer diagnosis.

Background: Historically, the New Mexico Veterans Affairs Healthcare System (NMVAHCS) has provided care to a predominately male population. However, this demographic is evolving significantly due to an increased number of women serving during Operation Iraqi Freedom and Operation Enduring Freedom conflicts and with improved detection women are being diagnosed younger. Younger women diagnosed with breast cancer experience unique concerns and providers often neglect or avoid discussions involving these difficult topics.

Methods: We utilized grant funding through Living Beyond Breast Cancer (LBBC) to provide education and outreach support specific for younger women diagnosed before 45 years of age. The Surgical Cancer Care Coordinator attended training and was provided educational slide content, handouts, and media templates to promote on-site educational seminars. Four sessions were held: sex and intimacy, early menopause, late complications, and the role of genetics. Telehealth allowed women in rural sections of the state to participate.

Results: Pre and post-surveys were conducted at each session. Pre-survey results: 10% of attendees reported providers initiated sexual function conversations and 5% stated providers seemed comfortable answering questions regarding sexual function Postsurvey results: 100% of attendees felt empowered with knowledge and resources to improve intimacy and sexual relations with their partners. All 4 sessions provided information on topics not previously discussed and developed camaraderie support.

Conclusion: Educating and encouraging young women to discuss symptoms with their providers remains essential. While the VAHCS begins to increase access to women’s health, facilities can develop community partnerships to support unmet needs. Partnering with LBBC Young Women’s Initiative is an example of improving survivorship care without impacting facility budgets or experiencing bureaucratic constraints.

Purpose: To improve breast cancer care and support services to the growing population of younger female Veterans diagnosed with breast cancer. To develop partnerships with non-profit community resources to meet specif c needs and increase resources for all patients living with a breast cancer diagnosis.

Background: Historically, the New Mexico Veterans Affairs Healthcare System (NMVAHCS) has provided care to a predominately male population. However, this demographic is evolving significantly due to an increased number of women serving during Operation Iraqi Freedom and Operation Enduring Freedom conflicts and with improved detection women are being diagnosed younger. Younger women diagnosed with breast cancer experience unique concerns and providers often neglect or avoid discussions involving these difficult topics.

Methods: We utilized grant funding through Living Beyond Breast Cancer (LBBC) to provide education and outreach support specific for younger women diagnosed before 45 years of age. The Surgical Cancer Care Coordinator attended training and was provided educational slide content, handouts, and media templates to promote on-site educational seminars. Four sessions were held: sex and intimacy, early menopause, late complications, and the role of genetics. Telehealth allowed women in rural sections of the state to participate.

Results: Pre and post-surveys were conducted at each session. Pre-survey results: 10% of attendees reported providers initiated sexual function conversations and 5% stated providers seemed comfortable answering questions regarding sexual function Postsurvey results: 100% of attendees felt empowered with knowledge and resources to improve intimacy and sexual relations with their partners. All 4 sessions provided information on topics not previously discussed and developed camaraderie support.

Conclusion: Educating and encouraging young women to discuss symptoms with their providers remains essential. While the VAHCS begins to increase access to women’s health, facilities can develop community partnerships to support unmet needs. Partnering with LBBC Young Women’s Initiative is an example of improving survivorship care without impacting facility budgets or experiencing bureaucratic constraints.

Introduction: The Commission on Cancer (COC), the New Mexico VA Health Care System (NMVAHCS) accrediting body for cancer care, mandates 25% of nurses maintain oncology nurse certification (OCN) to validate competency. However, the NMVAHCS remains deficient: threatening facility ability to maintain accreditation. Per the Oncology Nursing Certification Corporation, Albuquerque maintains 160 OCNs. However, 50% have retired and the remaining 50% are over 52. Leaving approximately 40 OCN nurses in a population of 500,000. This problem was not only a NMVAHCS problem, but a community problem: affecting quality of oncology care.

Problem: Not only is certification required for COC accredited facilities, it represents validation of expertise and skill set. Validation serves to build trust of Veterans, enables superior clinical judgment, and contributes to improved outcomes. With the Choice Program, many Veterans can leave the VAHCS. Certification serves to build necessary confidence required to keep Veterans within the VAHCS.

Methods: Barriers prohibiting certification were identified through survey of oncology nurses. Nurses reported fear related to failure, study material costs, exam fees, lack of mentors, and lack of internal leadership encouragement and support as barriers of certification. Funding was sought to provide a review course for 40 nurses, study guides, reimbursement of course and exam fees and held June 2017 in Albuquerque, New Mexico. A second review course, held during the 2017 AVAHO meeting, was conducted for another 24 nurses. The courses aimed to build confidence and decrease barriers. Both exceeded capacity.

Results: As a result of the Albuquerque course, VISN 22 and non-VA nurses attended from several states. Each received
a 30% reduction in exam fees and were eligible for exam reimbursement after passing: 50% of attendees are now OCNs.

The AVAHO course, to date, has resulted in an additional 2 OCNs, 2 certification renewals, and an additional 5 are registered for the exam. Those not taking the exam cite lack of leadership support and encouragement as the main
barrier.

Implications: Certification validates care provided and builds Veterans trust: necessary with Choice. Facilities that retain a strong foundation of OCNs, mentor staff, and maintain leadership support remain more apt to produce and sustain certified nurses. Therefore, leadership buy-in remains essential.

Introduction: The Commission on Cancer (COC), the New Mexico VA Health Care System (NMVAHCS) accrediting body for cancer care, mandates 25% of nurses maintain oncology nurse certification (OCN) to validate competency. However, the NMVAHCS remains deficient: threatening facility ability to maintain accreditation. Per the Oncology Nursing Certification Corporation, Albuquerque maintains 160 OCNs. However, 50% have retired and the remaining 50% are over 52. Leaving approximately 40 OCN nurses in a population of 500,000. This problem was not only a NMVAHCS problem, but a community problem: affecting quality of oncology care.

Problem: Not only is certification required for COC accredited facilities, it represents validation of expertise and skill set. Validation serves to build trust of Veterans, enables superior clinical judgment, and contributes to improved outcomes. With the Choice Program, many Veterans can leave the VAHCS. Certification serves to build necessary confidence required to keep Veterans within the VAHCS.

Methods: Barriers prohibiting certification were identified through survey of oncology nurses. Nurses reported fear related to failure, study material costs, exam fees, lack of mentors, and lack of internal leadership encouragement and support as barriers of certification. Funding was sought to provide a review course for 40 nurses, study guides, reimbursement of course and exam fees and held June 2017 in Albuquerque, New Mexico. A second review course, held during the 2017 AVAHO meeting, was conducted for another 24 nurses. The courses aimed to build confidence and decrease barriers. Both exceeded capacity.

Results: As a result of the Albuquerque course, VISN 22 and non-VA nurses attended from several states. Each received
a 30% reduction in exam fees and were eligible for exam reimbursement after passing: 50% of attendees are now OCNs.

The AVAHO course, to date, has resulted in an additional 2 OCNs, 2 certification renewals, and an additional 5 are registered for the exam. Those not taking the exam cite lack of leadership support and encouragement as the main
barrier.

Implications: Certification validates care provided and builds Veterans trust: necessary with Choice. Facilities that retain a strong foundation of OCNs, mentor staff, and maintain leadership support remain more apt to produce and sustain certified nurses. Therefore, leadership buy-in remains essential.

Introduction: The Commission on Cancer (COC), the New Mexico VA Health Care System (NMVAHCS) accrediting body for cancer care, mandates 25% of nurses maintain oncology nurse certification (OCN) to validate competency. However, the NMVAHCS remains deficient: threatening facility ability to maintain accreditation. Per the Oncology Nursing Certification Corporation, Albuquerque maintains 160 OCNs. However, 50% have retired and the remaining 50% are over 52. Leaving approximately 40 OCN nurses in a population of 500,000. This problem was not only a NMVAHCS problem, but a community problem: affecting quality of oncology care.

Problem: Not only is certification required for COC accredited facilities, it represents validation of expertise and skill set. Validation serves to build trust of Veterans, enables superior clinical judgment, and contributes to improved outcomes. With the Choice Program, many Veterans can leave the VAHCS. Certification serves to build necessary confidence required to keep Veterans within the VAHCS.

Methods: Barriers prohibiting certification were identified through survey of oncology nurses. Nurses reported fear related to failure, study material costs, exam fees, lack of mentors, and lack of internal leadership encouragement and support as barriers of certification. Funding was sought to provide a review course for 40 nurses, study guides, reimbursement of course and exam fees and held June 2017 in Albuquerque, New Mexico. A second review course, held during the 2017 AVAHO meeting, was conducted for another 24 nurses. The courses aimed to build confidence and decrease barriers. Both exceeded capacity.

Results: As a result of the Albuquerque course, VISN 22 and non-VA nurses attended from several states. Each received
a 30% reduction in exam fees and were eligible for exam reimbursement after passing: 50% of attendees are now OCNs.

The AVAHO course, to date, has resulted in an additional 2 OCNs, 2 certification renewals, and an additional 5 are registered for the exam. Those not taking the exam cite lack of leadership support and encouragement as the main
barrier.

Implications: Certification validates care provided and builds Veterans trust: necessary with Choice. Facilities that retain a strong foundation of OCNs, mentor staff, and maintain leadership support remain more apt to produce and sustain certified nurses. Therefore, leadership buy-in remains essential.

Purpose: Evaluate the impact of extracellular matrix on bowel anastomotic complications.

Background: The incidence of anastomotic leak is 1-33%. It remains the most feared colorectal surgical complication leading to sepsis and death. Anastomotic leaks alter bowel function and overall cancer survival.

Methods: We retrospectively reviewed a single surgeon’s experience at our VAMC. From January 1, 2012 to December 1, 2014, 50 patients had bowel anastomoses performed without reinforcement. Due to complications, we began using extracellular matrix as reinforcement for all bowel anastomoses. From October 31, 2014 to May 19, 2017, 66 reinforced bowel anastomoses were performed.

Results: 50 anastomoses were completed in the first 23 months. 12 ileostomy reversals/small bowel anastomoses were completed without leaks. 12 ileo-colonic anastomoses resulted in 1 abscess requiring interventional radiology drainage for several months, which ultimately healed. 13 left-sided anastomoses were completed without complication. 13 low anterior anastomoses were performed: 2 leaks resulted in 2 patients after chemoradiation despite fecal diversion. 1 resulted in a complete stenosis and remains diverted. The second underwent revision with colo-anal pull through and resulted in complete stenosis requiring completion APR. Neither returned to bowel continuity.

After bowel reinforcement was begun, 66 bowel anastomoses were completed in 31 months. 9 ileostomy reversal/small bowel anastomoses were completed, without leaks. 33 ileo-colonic anastomoses resulted without leaks. 9 left-sided anastomoses were completed resulting in 2 leaks: both were suture repaired and had fecal diversion. Neither resulted in stenosis. 1 has returned to bowel continuity and the other is pending. 9 Low anterior anastomoses were performed: 3 leaks resulted in 3 patients. 1 required completion APR due to low location. The remaining 2 were
treated with drainage and fecal diversion. However, both healed without stenosis and were restored to bowel continuity.

Conclusions: Many new technologies have been investigated to reduce anastomotic complications. None have proven to work effectively. In our experience, extracellular matrix as reinforcement agent showed a trend in limiting the severity of the anastomotic leak and furthermore appears to limit progression to stenosis and affords return to bowel continuity: improving surgical quality outcomes.

Purpose: Evaluate the impact of extracellular matrix on bowel anastomotic complications.

Background: The incidence of anastomotic leak is 1-33%. It remains the most feared colorectal surgical complication leading to sepsis and death. Anastomotic leaks alter bowel function and overall cancer survival.

Methods: We retrospectively reviewed a single surgeon’s experience at our VAMC. From January 1, 2012 to December 1, 2014, 50 patients had bowel anastomoses performed without reinforcement. Due to complications, we began using extracellular matrix as reinforcement for all bowel anastomoses. From October 31, 2014 to May 19, 2017, 66 reinforced bowel anastomoses were performed.

Results: 50 anastomoses were completed in the first 23 months. 12 ileostomy reversals/small bowel anastomoses were completed without leaks. 12 ileo-colonic anastomoses resulted in 1 abscess requiring interventional radiology drainage for several months, which ultimately healed. 13 left-sided anastomoses were completed without complication. 13 low anterior anastomoses were performed: 2 leaks resulted in 2 patients after chemoradiation despite fecal diversion. 1 resulted in a complete stenosis and remains diverted. The second underwent revision with colo-anal pull through and resulted in complete stenosis requiring completion APR. Neither returned to bowel continuity.

After bowel reinforcement was begun, 66 bowel anastomoses were completed in 31 months. 9 ileostomy reversal/small bowel anastomoses were completed, without leaks. 33 ileo-colonic anastomoses resulted without leaks. 9 left-sided anastomoses were completed resulting in 2 leaks: both were suture repaired and had fecal diversion. Neither resulted in stenosis. 1 has returned to bowel continuity and the other is pending. 9 Low anterior anastomoses were performed: 3 leaks resulted in 3 patients. 1 required completion APR due to low location. The remaining 2 were
treated with drainage and fecal diversion. However, both healed without stenosis and were restored to bowel continuity.

Conclusions: Many new technologies have been investigated to reduce anastomotic complications. None have proven to work effectively. In our experience, extracellular matrix as reinforcement agent showed a trend in limiting the severity of the anastomotic leak and furthermore appears to limit progression to stenosis and affords return to bowel continuity: improving surgical quality outcomes.

Purpose: Evaluate the impact of extracellular matrix on bowel anastomotic complications.

Background: The incidence of anastomotic leak is 1-33%. It remains the most feared colorectal surgical complication leading to sepsis and death. Anastomotic leaks alter bowel function and overall cancer survival.

Methods: We retrospectively reviewed a single surgeon’s experience at our VAMC. From January 1, 2012 to December 1, 2014, 50 patients had bowel anastomoses performed without reinforcement. Due to complications, we began using extracellular matrix as reinforcement for all bowel anastomoses. From October 31, 2014 to May 19, 2017, 66 reinforced bowel anastomoses were performed.

Results: 50 anastomoses were completed in the first 23 months. 12 ileostomy reversals/small bowel anastomoses were completed without leaks. 12 ileo-colonic anastomoses resulted in 1 abscess requiring interventional radiology drainage for several months, which ultimately healed. 13 left-sided anastomoses were completed without complication. 13 low anterior anastomoses were performed: 2 leaks resulted in 2 patients after chemoradiation despite fecal diversion. 1 resulted in a complete stenosis and remains diverted. The second underwent revision with colo-anal pull through and resulted in complete stenosis requiring completion APR. Neither returned to bowel continuity.

After bowel reinforcement was begun, 66 bowel anastomoses were completed in 31 months. 9 ileostomy reversal/small bowel anastomoses were completed, without leaks. 33 ileo-colonic anastomoses resulted without leaks. 9 left-sided anastomoses were completed resulting in 2 leaks: both were suture repaired and had fecal diversion. Neither resulted in stenosis. 1 has returned to bowel continuity and the other is pending. 9 Low anterior anastomoses were performed: 3 leaks resulted in 3 patients. 1 required completion APR due to low location. The remaining 2 were
treated with drainage and fecal diversion. However, both healed without stenosis and were restored to bowel continuity.

Conclusions: Many new technologies have been investigated to reduce anastomotic complications. None have proven to work effectively. In our experience, extracellular matrix as reinforcement agent showed a trend in limiting the severity of the anastomotic leak and furthermore appears to limit progression to stenosis and affords return to bowel continuity: improving surgical quality outcomes.

Problem: With improved treatment modalities, cancer has become a chronic disease. However, without appropriate surveillance Veteran outcomes fall short of expected survival rates.

Extended longevity increases the likelihood of recurrence. The potential for development of secondary diseases or other iatrogenic disorders caused by cancer treatments also increases over time. Therefore, appropriate surveillance remains essential for detection of early complications: improving Veterans outcomes and value.

Background: Commission on Cancer accreditation requires provision of a survivorship care plan (SCP): retroactive disease and treatment information abstracted from the medical record provided at the end of treatment. The intent aims to increase communication of care as patients transition from oncology specialists. However, waiting until the completion of care fails to provide value for our Veteran or improve quality outcomes during the cancer treatment trajectory and active surveillance phase.

Our Veteran population remains stoic, ignoring symptoms requiring medical attention until symptoms become unbearable. By this time, disease progression is usually advanced. Veterans present to the emergency room in late stages of disease requiring emergent surgeries or chemotherapeutic treatments. Regrettably, such costly interventions lack extended value and only serve to stabilize or palliate symptoms: leading to poor overall Veteran outcomes and litigation liabilities for the facility.

Methods: The New Mexico VAHCS process remains different: a proactive approach, beginning at diagnosis. Imbedded health factors in the SCP, capture the provider’s individualized plan for each Veteran: identifying when surveillance care is due. Utilizing technology, the Central Data Warehouse captures this plan and populates the Cancer Dashboard. Previously, monitoring such plans remained tedious: relying on Excel spreadsheets. However, the creation of the Dashboard allows proactive identification of Veterans needing care.

Results: This system has enabled trusting relationships with our Veterans. Since implementation, the no-show rate of Veterans living with cancer has decreased from 53% to 0.09%: enabling timely care.

Conclusions: The use of health factors in proactive formats improves quality care and provides data: offering information to monitor quality metrics and establish benchmarks: improving the delivery of evidence-based care. Automation prevents loss to follow-up, decreases duplication of services, prevents omissions, and delivery of unnecessary care.

Problem: With improved treatment modalities, cancer has become a chronic disease. However, without appropriate surveillance Veteran outcomes fall short of expected survival rates.

Extended longevity increases the likelihood of recurrence. The potential for development of secondary diseases or other iatrogenic disorders caused by cancer treatments also increases over time. Therefore, appropriate surveillance remains essential for detection of early complications: improving Veterans outcomes and value.

Background: Commission on Cancer accreditation requires provision of a survivorship care plan (SCP): retroactive disease and treatment information abstracted from the medical record provided at the end of treatment. The intent aims to increase communication of care as patients transition from oncology specialists. However, waiting until the completion of care fails to provide value for our Veteran or improve quality outcomes during the cancer treatment trajectory and active surveillance phase.

Our Veteran population remains stoic, ignoring symptoms requiring medical attention until symptoms become unbearable. By this time, disease progression is usually advanced. Veterans present to the emergency room in late stages of disease requiring emergent surgeries or chemotherapeutic treatments. Regrettably, such costly interventions lack extended value and only serve to stabilize or palliate symptoms: leading to poor overall Veteran outcomes and litigation liabilities for the facility.

Methods: The New Mexico VAHCS process remains different: a proactive approach, beginning at diagnosis. Imbedded health factors in the SCP, capture the provider’s individualized plan for each Veteran: identifying when surveillance care is due. Utilizing technology, the Central Data Warehouse captures this plan and populates the Cancer Dashboard. Previously, monitoring such plans remained tedious: relying on Excel spreadsheets. However, the creation of the Dashboard allows proactive identification of Veterans needing care.

Results: This system has enabled trusting relationships with our Veterans. Since implementation, the no-show rate of Veterans living with cancer has decreased from 53% to 0.09%: enabling timely care.

Conclusions: The use of health factors in proactive formats improves quality care and provides data: offering information to monitor quality metrics and establish benchmarks: improving the delivery of evidence-based care. Automation prevents loss to follow-up, decreases duplication of services, prevents omissions, and delivery of unnecessary care.

Problem: With improved treatment modalities, cancer has become a chronic disease. However, without appropriate surveillance Veteran outcomes fall short of expected survival rates.

Extended longevity increases the likelihood of recurrence. The potential for development of secondary diseases or other iatrogenic disorders caused by cancer treatments also increases over time. Therefore, appropriate surveillance remains essential for detection of early complications: improving Veterans outcomes and value.

Background: Commission on Cancer accreditation requires provision of a survivorship care plan (SCP): retroactive disease and treatment information abstracted from the medical record provided at the end of treatment. The intent aims to increase communication of care as patients transition from oncology specialists. However, waiting until the completion of care fails to provide value for our Veteran or improve quality outcomes during the cancer treatment trajectory and active surveillance phase.

Our Veteran population remains stoic, ignoring symptoms requiring medical attention until symptoms become unbearable. By this time, disease progression is usually advanced. Veterans present to the emergency room in late stages of disease requiring emergent surgeries or chemotherapeutic treatments. Regrettably, such costly interventions lack extended value and only serve to stabilize or palliate symptoms: leading to poor overall Veteran outcomes and litigation liabilities for the facility.

Methods: The New Mexico VAHCS process remains different: a proactive approach, beginning at diagnosis. Imbedded health factors in the SCP, capture the provider’s individualized plan for each Veteran: identifying when surveillance care is due. Utilizing technology, the Central Data Warehouse captures this plan and populates the Cancer Dashboard. Previously, monitoring such plans remained tedious: relying on Excel spreadsheets. However, the creation of the Dashboard allows proactive identification of Veterans needing care.

Results: This system has enabled trusting relationships with our Veterans. Since implementation, the no-show rate of Veterans living with cancer has decreased from 53% to 0.09%: enabling timely care.

Conclusions: The use of health factors in proactive formats improves quality care and provides data: offering information to monitor quality metrics and establish benchmarks: improving the delivery of evidence-based care. Automation prevents loss to follow-up, decreases duplication of services, prevents omissions, and delivery of unnecessary care.