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Fighting Cancer: Finding the Right Approach

Joe Cantlupe, for HealthLeaders Media, July 14, 2010
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Cancer care involves a myriad of treatment options as it becomes more pervasive yet more controlled. More approaches are taking hold as various and innovative treatment options are explored, using a range of approaches.

The cost of treating cancer in the United States has nearly doubled over the past two decades. A study by the CDC, Emory University, and RTI International released in May shows that the rising costs have been driven most significantly by the sheer number of patients, not by the cost of treatment or cancer drugs, which also have become more costly.

As a result, multidisciplinary approaches are essential as cancer cases are expected to continue to rise, with an increased focus on outpatient care to maintain a competitive service line, says Kevin J. Cullen, MD, director of the University of Maryland Greenebaum Cancer Center. "Over the last 20 years, we have moved oncology services from predominantly inpatient to overwhelmingly outpatient," Cullen says. "Only those with very severe illnesses and who have complications are now inpatient," he adds.

The evolution of data and communication systems overseeing management of the disease and continued improvement of interaction between physicians and patients also will continue to be a key element in developing a cancer service line, says Cullen, whose hospital is developing pilot programs to improve patient and physician access to information about illness, regardless of their location.

"It's communication on many levels, physician and patient, and it's communicating with people who need access to specialized care at a distance," Cullen says. "It will ultimately drive down costs and reduce unnecessary hospitalizations," he says.

That means finding the right approaches for innovation in a highly competitive environment.

At Cincinnati Children's Hospital Medical Center, for instance, a clinical program has been launched to address problems in medication adherence related to young pediatric patients. "If you improve adherence and reduce symptoms and complications, you are reducing costs," says Dennis Drotar, PhD, director of the hospital's Center for Adherence and Self-Management.

In recent years, in oncology care, the focus has been on coordinated care and "patient care," says Tracy K. Johnson, FACHE, vice president of Health Strategies & Solutions, a Philadelphia-based healthcare consultant. Determining the right diagnosis and treatment plan "is becoming ever more complex, requiring input from many experts," she says.

Success Key No. 1: Creating process efficiencies

At the Cancer Treatment Centers of America over the past several years, leadership worked to overhaul its treatment program and the result is improved outcomes, says Timothy Birdsall, ND, vice president of integrative medicine at CTCA.

For instance: What was the amount of time patients spent in the waiting area to receive chemotherapy infusions through port access procedures? The centers focused on the problem and reduced waiting times by more than 75%, from over 40 minutes to an average of 10 minutes, says Birdsall.

The hospital administration evaluated the times and daily peaks of activity and implemented new scheduling guidelines. As a result, appointment schedules were changed from 15-minute time slots to 20-minute time slots, preventing unnecessary delays, he says. Instead of depending on the lab technicians to print patient port access labels, the department's secretary now prints them as each patient arrives. Birdsall says they used a process known as Lean Thinking.

"We have found that patients value reduced wait times," Birdsall says. The process helps achieve efficiency "with an intensive consumer-centric focus on what patients want and value in their treatment" and also enables removing waste, increasing operational efficiency, and improving patient satisfaction, he adds.

Birdsall oversees a treatment model that combines conventional medical treatments with complementary therapies supported by scientific research. Birdsall says the treatment approach allows the hospital to bring together traditional elements for fighting cancer, such as surgery and chemotherapy, with other therapies, such as nutritional support, naturopathic and mind-body medicine, pain management, and spiritual support.

As part of the multidisciplinary approach, CTCA tracks each patient's ability to perform basic activities of daily living and his or her overall sense of well-being through special care teams that monitor and address cancer-related symptoms such as fatigue, insomnia, and pain.

CTCA "has an entire care delivery team of providers—a permanent team for each patient—and they work every day with a single patient as a team," Birdsall says.

"We have created a structure and a flow which facilitates team-based care. Teams are used throughout healthcare, but often the structure of the clinic experience, the integration between inpatient and outpatient, and the number and diversity of disciplines involved actually detracts from, rather than adds to, the process and experience for the patient," Birdsall says. "The care team comes to the patient, one by one, while the patient stays in one room, following a single check-in for multiple appointments. And the patient's care team will be even more specialized to his or her condition."

The hospital system developed a comprehensive electronic health record system that allows for data collection, mining, and analysis of hospital records, and a "clinical outcomes initiative" to empower patients with necessary data to make informed decisions under what is being launched as a Patient-Empowered Care model.

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