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Developing Community Partnerships to Improve Breast Cancer Survivorship for Young Women
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.
Application of Extracellular Matrix to Reinforce Bowel Anstomoses in Colorectal Surgery: Does It Make a Difference in Clinically Significant Leaks?
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.
Automation of Cancer Surveillance Care: Using Technology to Improve Outcomes of 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.
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.
Strollin’ the Colon: A Collaborated Effort to Provide Education and Screening Outreach for the Improvement of Awareness, Access, and Early Detection of Colorectal Cancer
Purpose: In 2015, the New Mexico VA Health Care System completion of colorectal cancer screening fell below the national VA average of 82%. The facility Healthcare Effectiveness Data and Information Set (HEDIS) mean aggregated data for Colorectal Cancer Screening was 74.14%. This presents an alarming truth: the failure to screen 25% of the Veteran population served.
The projects purpose stands to improve quality outcomes through the early detection and prevention of colorectal cancer by increasing provider and Veteran awareness.
Relevant Background/Problem: Colorectal cancer is the third leading cause of cancer deaths and remains preventable through appropriate and timely screening. In 2012, 134,784 people in the United States were diagnosed with colorectal cancer, of which 51,516 people died.
Barriers leading to low screening compliance include knowledge deficits, fear, access, and common myths and misconceptions. Providers and Veterans fail to understand the difference of recommended screening anddiagnostic guidelines; available prevention/ detection options/ personal risk factors; ultimately neglecting screening completion due to lack of symptoms.
Methods: We held an Outreach Colorectal Cancer Awareness Fair for the community. A 20-foot long inflatable colon, depicting various stages of abnormalities was brought in. Attendees completed screening questionnaires, focusing on risk factors/ history/ symptoms. These were reviewed on site with providers, and appropriate care was ordered: colonoscopy or FIT testing. Various educational booths served to provide education using evidence-based data. Follow-up letters and calls after the event served to increase Veteran compliance. The local news station showcased the VAMC in a positive light.
Results: We had 355 attendees. 104 Veterans completed screening. 71% of Veterans were identified as needing further diagnostic testing based on provider assessment. 6 Veterans were given FIT packets on that day; an additional 17 were later identified based on review of forms (total 22%). Initial return rate of FIT cards was 83%, exceeding facility norm, and 51 Veterans were scheduled for colonoscopy (49%).
Implications: The overall outcome from this event has been to greatly improve attitudes from the level of the patient and employee volunteers to the community and upper management: improving the overall awareness to screening and diagnostic modalities for colorectal cancer.
Purpose: In 2015, the New Mexico VA Health Care System completion of colorectal cancer screening fell below the national VA average of 82%. The facility Healthcare Effectiveness Data and Information Set (HEDIS) mean aggregated data for Colorectal Cancer Screening was 74.14%. This presents an alarming truth: the failure to screen 25% of the Veteran population served.
The projects purpose stands to improve quality outcomes through the early detection and prevention of colorectal cancer by increasing provider and Veteran awareness.
Relevant Background/Problem: Colorectal cancer is the third leading cause of cancer deaths and remains preventable through appropriate and timely screening. In 2012, 134,784 people in the United States were diagnosed with colorectal cancer, of which 51,516 people died.
Barriers leading to low screening compliance include knowledge deficits, fear, access, and common myths and misconceptions. Providers and Veterans fail to understand the difference of recommended screening anddiagnostic guidelines; available prevention/ detection options/ personal risk factors; ultimately neglecting screening completion due to lack of symptoms.
Methods: We held an Outreach Colorectal Cancer Awareness Fair for the community. A 20-foot long inflatable colon, depicting various stages of abnormalities was brought in. Attendees completed screening questionnaires, focusing on risk factors/ history/ symptoms. These were reviewed on site with providers, and appropriate care was ordered: colonoscopy or FIT testing. Various educational booths served to provide education using evidence-based data. Follow-up letters and calls after the event served to increase Veteran compliance. The local news station showcased the VAMC in a positive light.
Results: We had 355 attendees. 104 Veterans completed screening. 71% of Veterans were identified as needing further diagnostic testing based on provider assessment. 6 Veterans were given FIT packets on that day; an additional 17 were later identified based on review of forms (total 22%). Initial return rate of FIT cards was 83%, exceeding facility norm, and 51 Veterans were scheduled for colonoscopy (49%).
Implications: The overall outcome from this event has been to greatly improve attitudes from the level of the patient and employee volunteers to the community and upper management: improving the overall awareness to screening and diagnostic modalities for colorectal cancer.
Purpose: In 2015, the New Mexico VA Health Care System completion of colorectal cancer screening fell below the national VA average of 82%. The facility Healthcare Effectiveness Data and Information Set (HEDIS) mean aggregated data for Colorectal Cancer Screening was 74.14%. This presents an alarming truth: the failure to screen 25% of the Veteran population served.
The projects purpose stands to improve quality outcomes through the early detection and prevention of colorectal cancer by increasing provider and Veteran awareness.
Relevant Background/Problem: Colorectal cancer is the third leading cause of cancer deaths and remains preventable through appropriate and timely screening. In 2012, 134,784 people in the United States were diagnosed with colorectal cancer, of which 51,516 people died.
Barriers leading to low screening compliance include knowledge deficits, fear, access, and common myths and misconceptions. Providers and Veterans fail to understand the difference of recommended screening anddiagnostic guidelines; available prevention/ detection options/ personal risk factors; ultimately neglecting screening completion due to lack of symptoms.
Methods: We held an Outreach Colorectal Cancer Awareness Fair for the community. A 20-foot long inflatable colon, depicting various stages of abnormalities was brought in. Attendees completed screening questionnaires, focusing on risk factors/ history/ symptoms. These were reviewed on site with providers, and appropriate care was ordered: colonoscopy or FIT testing. Various educational booths served to provide education using evidence-based data. Follow-up letters and calls after the event served to increase Veteran compliance. The local news station showcased the VAMC in a positive light.
Results: We had 355 attendees. 104 Veterans completed screening. 71% of Veterans were identified as needing further diagnostic testing based on provider assessment. 6 Veterans were given FIT packets on that day; an additional 17 were later identified based on review of forms (total 22%). Initial return rate of FIT cards was 83%, exceeding facility norm, and 51 Veterans were scheduled for colonoscopy (49%).
Implications: The overall outcome from this event has been to greatly improve attitudes from the level of the patient and employee volunteers to the community and upper management: improving the overall awareness to screening and diagnostic modalities for colorectal cancer.