整合美国国立综合癌症网络（NCCN）痛苦筛查工具，作为电话肿瘤病例管理的指导原则。

Integration of the National Comprehensive Cancer Network (NCCN) Distress Screening Tool as a Guidepost for Telephonic Oncology Case Management.

作者信息

Swanson Alysia Jean, Castel Liana DesHarnais, McKenna Patricia A, Shen Yuming Albert, Sagar Bhuvana

机构信息

Alysia Jean Swanson, BSOM, RN, CCM, leads Clinical Program Development and clinical oversight of Cigna's Oncology Case Management program as Clinical Program Development Manager at Cigna. A certified case manager and Six Sigma Green Belt, she serves as a board member for the Oncology Nurse Society of Chattanooga Tennessee. Liana DesHarnais Castel, PhD, MSPH, is Editor-in-Chief of Patient Related Outcome Measures (Dove Medical Press, part of Taylor & Francis Group), Adjunct Professor at Campbell University Lundy-Fetterman School of Business, and Business Communication Senior Specialist at Cigna. She holds PhD and MSPH degrees from University of North Carolina-Chapel Hill. Patricia A. McKenna, BSN, RN, is currently a Project Manager with Cigna Consumer Health Engagement. She received her BSN from Creighton University, College of Nursing, and is a Certified Six Sigma Green Belt. Yuming Albert Shen, PhD, holds the position of Informatics and Analytics Senior Specialist at Cigna. He holds a PhD in biophysics from University of Virginia, a PhD in statistics from Virginia Tech, and a master's degree in statistics from Columbia University in the City of New York. Bhuvana Sagar, MD, is Lead Medical Director at Cigna. She completed her MD from Kilpauk Medical College in Chennai, India, residency at St. Luke's-Roosevelt Hospital Center, New York, NY, and fellowship at University of Texas-Medical Branch, Galveston, TX. She is board certified in Internal Medicine and Medical Oncology and actively licensed in Texas.

出版信息

Prof Case Manag. 2019 May/Jun;24(3):148-154. doi: 10.1097/NCM.0000000000000336.

DOI:10.1097/NCM.0000000000000336

PMID:30946253

Abstract

PURPOSE OF STUDY

Cigna's oncology case management programs identified the opportunity for case managers to integrate distress screening as recommended by the National Comprehensive Cancer Network (NCCN) in oncology populations. Our purpose in conducting this study was to quantify oncology case management program improvements as a result of using the NCCN Distress Screening Tool to guide telephonic case management. The program improvements we measured comprised more efficient identification of biopsychosocial problems and appropriate resource referrals.

PRIMARY PRACTICE SETTING

Case managers in a large commercial health plan piloted integration of distress screening into telephonic case management among U.S. oncology customers experiencing a new diagnosis or care transition from September 2016 to April 2017.

METHODOLOGY AND SAMPLE

A retrospective, matched case-control study was conducted among Cigna customers eligible for oncology case management. The pilot group of 317 received distress screening early in the oncology case management assessment. Outcomes included distress severity ranging from 0 to 10 (where 0 = no distress, 1-3 = mild, 4-7 = moderate, and 8-10 = severe), identification and number of biopsychosocial health problems, and percentage of direct resource referrals by case managers to supportive services.

RESULTS

More than half (54%) of the screened customers reported mild or greater distress, and there was a strong correlation between degree of distress and average numbers of biopsychosocial health problems or direct resource referrals. Screened customers were 16% more likely to be referred to internal and external resources than customers not screened with the tool (66% vs. 50%, χp < .001).

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

This study advances evidence-based oncology case management practice during care transitions by providing quantitative evidence for the utility of integrating the NCCN Distress Screening Tool into telephonic oncology case management. Using the tool (thermometer and problem list) to guide telephonic oncology case management and care coordination facilitated more tailored referrals to individuals with cancer enrolled in a large commercial health plan. On the basis of our findings, we integrated distress screening to address unmet biopsychosocial needs in patients with cancer.

摘要

研究目的

信诺保险的肿瘤病例管理项目发现，病例管理人员有机会按照美国国立综合癌症网络（NCCN）的建议，将痛苦筛查纳入肿瘤患者群体的管理中。我们开展这项研究的目的是量化肿瘤病例管理项目因使用NCCN痛苦筛查工具来指导电话病例管理而取得的改善。我们所衡量的项目改善包括更有效地识别生物心理社会问题以及进行适当的资源转介。

主要实践场景

2016年9月至2017年4月期间，一家大型商业健康保险计划中的病例管理人员在美国新确诊或正在经历护理过渡的肿瘤客户中，试行将痛苦筛查纳入电话病例管理。

方法与样本

对符合肿瘤病例管理条件的信诺保险客户进行了一项回顾性匹配病例对照研究。317人的试点组在肿瘤病例管理评估早期接受了痛苦筛查。结果包括0至10级的痛苦严重程度（其中0 = 无痛苦，1 - 3 = 轻度，4 - 7 = 中度，8 - 10 = 重度）、生物心理社会健康问题的识别及数量，以及病例管理人员向支持性服务直接转介资源的比例。

结果

超过一半（54%）接受筛查的客户报告有轻度或更严重的痛苦，痛苦程度与生物心理社会健康问题的平均数量或直接资源转介之间存在很强的相关性。与未使用该工具进行筛查的客户相比，接受筛查的客户被转介至内部和外部资源的可能性高16%（66%对50%，χp < .001）。

对病例管理实践的启示

本研究通过提供将NCCN痛苦筛查工具纳入电话肿瘤病例管理效用的定量证据，推动了护理过渡期间基于证据的肿瘤病例管理实践。使用该工具（温度计和问题清单）来指导电话肿瘤病例管理和护理协调，有助于为参加大型商业健康保险计划的癌症患者提供更具针对性的转介。基于我们的研究结果，我们纳入了痛苦筛查，以满足癌症患者未得到满足的生物心理社会需求。