A new clinical pathway for cancer patients at Christiana Care Health System's Helen F. Graham Cancer Center and Research Institute is improving their quality of life, providing better health outcomes and delivering lower healthcare costs, according to a study published in the current issue of the Journal of Clinical Pathways.
A clinical pathway is a tool for achieving high-quality, high-value care through standardization, ensuring that all patients who meet a given criteria receive consistent evidence-based care without unnecessary variation.
Called Supportive Care of Oncology Patients or SCOOP, the pathway launched in November 2016 and initially focused on patients with potentially curable thoracic, colorectal or head and neck cancers who were receiving combined chemotherapy and radiation through one of the Graham Cancer Center's multidisciplinary clinics.
Due to the nature of their treatment, these patients are at higher risk for debilitating side effects that can send them to the emergency department, such as dehydration from nausea and vomiting, pain or psychosocial distress.
For the first two years of the pathway, when compared to a control group of similar patients not on the pathway, SCOOP patients experienced fewer visits to the emergency department (34 versus 54 percent), fewer hospital admissions (23 versus 34 percent) and fewer readmissions (18 versus 32 percent).
Correspondingly, cost savings for pathway patients was estimated on average to be more than $1,500 per patient. The total cost savings for 207 SCOOP patients thru October 31, 2018, was more than $319,000.
Pathway-driven improvements included introducing supportive and palliative care management early in the patient experience and adding in an electronic nurse navigation checklist to keep everyone on track.
Recently, the pool of eligible patients expanded to include those with brain and hepatobiliary and pancreatic cancers. The team is looking to broaden participation further to more patients who might be at risk from a host of factors that could lead to increased emergency department visits and readmissions, including socioeconomic or financial concerns.
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On the SCOOP pathway, screening with the supportive and palliative care service is mandatory during the multidisciplinary clinic visit, and, if indicated, urgent or timely consultation.
A comprehensive nurse navigation electronic checklist sets mandatory tasks and milestones during treatment and follow-up as standard care.
Items included are dates for prescribed communication with patients, scheduled consults and reminders to assess additional or unmet needs throughout the course of treatment. As a quality control mechanism, the system requires navigators to opt out of, rather than put in, service consults such as nutrition, behavioral health or social work.
Flags in the inpatient information system alert the supportive care team, the navigators and the oncologists when a patient is seen, admitted or discharged from the emergency room.
Nurse navigator compliance with the new navigation system increased from 94 to 99 percent during the first year.