Hard-wiring survivorship care plan delivery.

Abstract

113 Background: As outlined by the Institute of Medicine (IOM) report, ASCO, the Commission on Cancer, survivorship care planning is an essential part of quality cancer care. Meeting SCP delivery standards is a challenge due to complex systems, difficulty identifying eligible patients, lack of clarity around roles and responsibilities, and time required to complete the care plans. Yale Cancer Center/Smilow Cancer Hospital is a NCI-designated comprehensive cancer center with 12 multidisciplinary cancer programs, a large cancer hospital and 10 care centers in the community. We have approximately 4000 early stage analytic cases per year. We set out to standardize SCP delivery. Methods: A group of multidisciplinary stakeholders convened to outline goals and identify needs. Based on gap analysis and review of national standards, a standard operating procedure for the creation and delivery of SCPs was developed. Models of care were outlined in the policy. Disease specific treatment summary and care plan templates for the most common cancer types were developed within our electronic medical record (EMR) based on ASCO standards and were vetted by disease team experts. The templates were built to minimize the need for manual entry of content. Automated alerts were developed within the EMR to trigger identification of eligible patients. An operational plan was developed for each clinical area to outline responsibilities for care plan creation and delivery. Results: Implementation of model survivorship care within each disease team and community site was performed over a period of one year. The number of care plans delivered has already increased by 20%. At least 10% of early stage analytic cases received SCPs in 2015. Conclusions: Meeting SCP standards in a large, single institution can be challenging. With a standard operating procedure, clear delineation of responsibility within teams, disease specific templates, and EMR tools to trigger visits, meeting these standards becomes an achievable goal. A systematic approach to developing comprehensive survivorship care in a large academic center can hardwire high quality patient care and compliance with standards.