JL302. The CARE (Clinical Assessment and Rapid Evaluation) Clinic: Improving the Oncology Patient Experience and Outcomes
Mary Jane LaRoche, MS, ANP-BC, AOCNS, ACHPN, Whitney Herter, PA-C, MHS, Sarah Eppers, RN, BSN, OCN, Nicole Giles, RN, BSN, OCN, Adam Poust, PharmD, James Bachman, Tom Purcell, MD, MBA, and Wells Messersmith, MD, FACP; University of Colorado Cancer Center, Aurora, CO
Oncology patient visits are anticipated to increase annually as the population ages with an estimated 24,540 new cancer diagnoses in Colorado in 2015. This year, University of Colorado Anschutz Cancer Pavilion (ACP) visits have increased by 14%. Chemotherapy dose intensity impacts patient outcomes, especially treatment with curative intent, with symptom management helping achieve this oncology quality indicator. Timely and appropriate symptom management is vital for cancer patients. Limited same day appointment availability in oncology clinics leads to patients being inappropriately directed to the emergency department (ED) to address issues such as fever, pain, and gastrointestinal symptoms that can be managed outpatient. In 2014, the ACP established the need for an advanced practice provider (APP)-led symptom management clinic. Baseline data collected from ED, inpatient admissions, and outpatient infusion visits along with National Comprehensive Cancer Network (NCCN) sites with similar clinics, reinforced the case for an acute symptom management clinic to address increased patient volumes. In February 2015, the CARE Clinic opened with limited hours staffing two APPs and an RN sharing busy infusion center resources. The global aim is to provide evidence-based symptom management to oncology patients with acute and chronic cancer and treatment related symptoms through improved access and quality care. Clinic goals include providing value-based care, avoiding unnecessary ED visits, reducing inpatient length of stay and readmissions, provision of multidisciplinary care, and enhancing cancer patient experiences and outcomes. By April clinic hours expanded fulltime on weekdays. Resource utilization, referral sources, basic demographics, cancer type, chief complaint, diagnoses, billing level and disposition (including ED avoidance and direct admissions) are tracked to help characterize patients utilizing services. Patient and internal customer experiences are surveyed with future plans to utilize the Edmonton Symptom Assessment System (ESAS-r). These metrics reveal opportunities to improve oncology care through the development of evidence-based guidelines with cancer specific pathways. Patient surveys and staff feedback have been very positive. Quality improvement with PDSA (Plan-Do-Study-Act) cycles to refine clinic capabilities and needs is ongoing. By six months, CARE Clinic services reached over 450 patient visits with 21% patient ED avoidance including direct admission.
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