Strategic planning for implementation of Commission on Cancer standard 3.3 in a tertiary academic center.

Abstract

58 Background: The Commission on Cancer (CoC) enacted a new accreditation standard (3.3) in 2012 to ensure cancer survivors treated with curative intent receive a Treatment Summary and Survivorship Care Plan (SCP) upon treatment completion. Accredited institutions reported challenges to meeting the standard such as lengthy completion time, lack of reimbursement, and limited personnel. In 2014, the CoC clarified 3.3 to allow a 5 year phased launch for institutions to be compliant by 2019. Yet, academic cancer centers continued to report difficulty in meeting annual targets. Methods: Annual goals for provision of SCPs to eligible survivors at The James Cancer Hospital were met in 2015 (10%) and 2016 (25%). Existing processes were not sufficient to meet the goal of 50% in 2017. Multiple stakeholders developed a performance improvement plan (PIP) to revise institutional practices to create a sustainable SCP delivery model. The Cancer Registry provided analytic case volumes. Results: Institutional barriers to SCP delivery included inconsistent data collection, multiple versions of a SCP, lack of personnel, a 3+ month wait time for information from Cancer Registry, and lack of provider awareness. Major tenets of the PIP were to: (1) integrate the SCP into the electronic medical record, (2) improve collection and accuracy of data, (3) initiate a hybrid (integrative and consultative) model of SCP delivery in which dedicated Advanced Practice Providers (APPs) are employed through a centralized survivorship center, (4) include provision of SCP as a metric on APP professional practice evaluations, (5) educate disease groups with high volumes of SCP eligible patients, (6) provide a quality scorecard, and (7) review eligibility criteria and the timeliness of Cancer Registry. Implementation of the PIP increased performance as the number of SCPs provided in January to September 2017 (n = 884) surpassed volume from the previous 2 years (2015 n = 617; 2016 n = 786). Conclusions: Academic cancer centers with high volumes of SCP eligible survivors often contend with barriers to meeting CoC standard 3.3. Implementation of the PIP, which improved performance in 2017, will be continually evaluated to meet the standard by 2019.