1. Cancer Program Standards 2012: Ensuring Patient-Centered Care
Stephen Dreyer, MD, FACS
October 22, 2014
CoC Surveyor
Fremont Health Medical Center
Fremont, Nebraska
The purpose of this presentation is to describe the benefits of an accredited cancer program to a healthcare facility. To accomplish this the following topics will be covered.
1. Describe the organizational structure and purpose
of a CoC Accredited Program.
2. Review the current status of the Accredited
Programs in your state
3. Describe the revisions to cancer program
standards that relate to quality care.
4. Demonstrate new initiatives involving quality
measures and outcomes assessment.
5. Assure patients that they are receiving quality care
close to home.

2. Evolution of Program Standards
Cancer Program Standards prior to 2004
Focused on structure and process to assure uniformity of care
Studies questioned Healthcare delivery system and the quality of care
Fragmented, poorly coordinated
Variability of care process
Adversely affected outcomes
National dialog on Quality of Care placed a strong emphasis on outcomes of health care activities. (4)

3. Cancer Program Changes
New focus on outcomes and delivering patient centered care meant that program standards needed to be revised
Support concept of quality care
Clinical stage – treatment plan - outcome
Expand the concept of care to provide individualized patient support
Data quality improved
Reporting tools need to be developed
Measurable - analyzed and improved
The CoC has responded to this new emphasis on outcomes by making significant cancer program changes. The new focus meant that the functions of the standards needed to be better integrated and effective in their purpose. New standards had to be created that expanded the concept of care and its delivery. The cancer activity related to each standard had to be done in a measurable way so that it could be analyzed and improved. Data quality needed to be improved and data reporting tools needed to be developed.

4. Commission on Cancer’s Response: ‘Cancer Program Standards 2012: Ensuring Patient-Centered Care’
Focus on quality of care via performance metrics quality improvement. Deliver in patient centered manner.
- Genetic assessment and counseling
- Palliative care services
- Increase clinical trial accruals
- Prevention and early screening
- Studies of quality and improvements
- Public reporting of outcomes
- Patient navigation (2015)
- Psychosocial distress screening (2015)
Survivorship care plan (2015)
Patient centered manner
Developed new patient-focused standards:
Genetic assessment and counseling
Palliative care services
Increased clinical trial accrual
Patient navigation (2015)
Psychosocial distress screening (2015)
Survivorship care plan (2015)
Address the full continuum of care and improving coordination
Increase participation in care decisions by patients and family
Increase patient satisfaction
New tools and practices to support standard implementation

5. Benefits of Patient-Centered Standards
Support customization of care each individual according to needs and circumstances (tool box)
Access
Decision making
Support during treatment
Survivorship
Respond to the specific needs of a community
reduce the burden of cancer
Incidence and stage of disease
Strengthens the partnership between public and healthcare system.
Just some of the key benefits to developing patient centered standards

6. Standard 4.1 Prevention Standard 4.2 Screening
Patient Outcomes
Standard 4.1 Prevention
Standard 4.2 Screening

7. Prevention Programs
S 4.1 Each year the cancer committee provides at least 1 cancer prevention program that is targeted to meet the needs of the community and should be designed to reduce the incidence of a specific cancer type. The prevention program is consistent with evidence based national guidelines for cancer prevention.

8. Prevention Programs Examples of cancer prevention programs:
Chemoprevention programs
Education/cancer awareness
Skin cancer prevention
Smoking cessation
Smoking prevention in adolescents
Nutrition, physical activity, and weight loss programs
Vaccination for HPV

9. Effective Prevention Program
Improve the health of a community reducing incidence
Identify community need
Study top 5 cancer sites
state cancer registry
NCI -
Factors and behaviors that could be altered reduce risk
Prevention activity should be based on a nationally recognized guideline
Activity is documented and results are analyzed

10. Incidence Lung Cancer Polk County

11. Incidence Lung Cancer by County

12. Elements of a Guideline
Study of the population
Defined invention is planned
Goal is established
Analysis of results

13. Cancer Prevention Guidelines
Search
Tobacco cessation
Adults cessation
Youth prevention
Quick Start Guide
Browse by Title
Filter term

14. NCI Books

15. NCI Book - Tobacco

16. NCI Books http://www.ncbi.nlm.nih.gov/books

17. Guideline Clearing House
Search on home page – tobacco cessation
Treatment of tobacco dependence
Smoking cessation services in primary care
Counseling and intervention in adults and pregnant women
Search
Organization
American Cancer Society
Topic

18. National Guideline Clearinghouse

19. List of Guidelines

20. Additional Resources Agency for Healthcare Research and Quality
Treating tobacco use and dependence
Guide to clinical preventive services

21. Implement Prevention Programs
Tobacco Cessation
team with other medical specialists tobacco affects outcome of the disease process
Incorporate smoking cessation activities into the routine treatment process
Pick new site each year
Periodically review the outcome and make improvements
Hospital community
Youth prevention

22. Implement Prevention Programs
Breast
Obesity and breast cancer risk
Annual mammogram
American Cancer Society information
High risk group identified for chemoprevention
Skin cancer
Incidence of melanoma

23. Implement Prevention Programs
Prevention programs continued the next year
Continuing need
Results can be improved
Education and cancer awareness lectures
Audience assessed for increased knowledge and need for action
Community needs assessment
Presented to the cancer committee and date
Used to select site and activity

24. Documentation for Compliance
Evidence in minutes
Cancer committee has assessed cancer prevention needs of the community
At least 1 prevention program has been conducted
Prevention program is consistent with an evidence based guideline and intervention
Results of the activity are evaluated by the cancer committee

25. Prevention Outcomes Measure, analyze, and improve – change Short term
Numbers of participants
Goal met
Effectiveness of education programs increasing knowledge and action
Long term
Reduction in the incidence of a specific site

26. Screening Program
S 4.2 Each year, the cancer committee provides at least 1 screening program that is targeted toward decreasing the number of patients with late stage disease. The screening program is based on community needs and is consistent with evidence based national guidelines and interventions. A process is developed to follow up on all positive findings.

27. Effective Screening Program
Support concept of quality care
Clinical stage – treatment plan – outcome
Identify area of need specific to service area of the cancer program
Establish an effective screening program
Conducted according to an established guideline
Deal with positive results

28. Community Need (Study)
Focus activities in sites with high number of late stage disease and specific patient groups
NCDB
Benchmark reports
Comparative studies
Number of variables

32. Stage by Age Group
Enter Your Text Here (if any) ©2009 National Cancer Data Base - Generated on Sep

35. Study Program Screening Results

38. Screening Guidelines American Cancer Society
National Comprehensive Cancer Network
Centers for Disease Control and Prevention

39. Documentation for Compliance
Evidence in minutes
Cancer committee identifies cancer screening needs of the community
At least 1 screening program has been conducted
Screening program is consistent with an evidence based guideline and intervention
Process is developed to deal with all positive findings
Results of the activity are evaluated by the cancer committee

40. Screening Outcomes Measure, analyze, and improve – change
Short term outcome
Numbers
First time screening
Participate in annual screening
Interval between screenings
Number with positive results referred
Long term outcome
Increased numbers of early stage disease

41. Questions?
Thank You