Meeting Abstract

JL520. Oncology Care Model and the Transformation of the APN Role in the Care of Patients Undergoing Chemotherapy

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ABSTRACT

Abstracts From 
JADPRO Live at APSHO 2017
Marriott Marquis, Houston, Texas • November 2–5, 2017

The posters for the abstracts below can be found at:
eventscribe.com/2017/posters/JADPROLIVE/home.asp

Objective/Background: The Center for Medicare Services Oncology Care Model (OCM) is defined as a quality improvement initiative focused on improving care for Medicare patients receiving chemotherapy. The Rutgers Cancer Institute of New Jersey began participating in the program in July 2016. The institute’s primary objective was to align our practice to the OCM framework. A secondary objective was to employ the advance practice nurses (APNs) to enhance care coordination, ensure appropriateness of care, and provide quality comprehensive care, while at the same time reducing expenditures.

Methods: Resources were realigned to include two full-time APN positions whose function was to address acute symptom management. Treatment area hours were extended from 7am to 7pm. Service calls were directed to the APNs from 5pm to 7pm. The OCM APNs were relocated to an office adjacent to the treatment center to streamline communications and workflow. All staff members and physicians were educated on APN availability and services of OCM APNs. The OCM framework was incorporated into APN practice including a comprehensive symptom assessment and psychosocial evaluation. Questionnaires were developed to document symptoms, and meet the performance metrics for OCM. The assessment also included advanced care planning, depression and emotional distress surveys. Through the evaluation of clinical pathways, referral triggers were defined, and incorporated into the flow of clinical care.

Results: In a 13-month period, 500 patients were assessed. Approximately 200 patients with symptom management issues were advised with appropriate interventions. Eighty-eight patients were referred to our social work department for further evaluation of depression and suicidal ideation. Additionally, a downward trend of emergency room visits and hospital readmissions has been demonstrated since the inception of the OCM program.

Conclusion: Through the addition of the OCM APNs, the institution’s practice was successfully transformed and aligned to meet the OCM guidelines. Utilization of the OCM questionnaires provided a structured approach to the delivery of comprehensive care. The OCM APNs were able to address, remediate, and share the responsibility of psychosocial issues, and improve the quality of care of our patients. Symptom management response time has been reduced.

Recommendations: It would be beneficial clinically and financially to expand the OCM model to all of our patients throughout the institution. In addition, the creation of a dedicated urgent care clinic for patients to access on non-treatment days would yield multiple benefits.

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