McGrath Elizabeth B, Schaal Anna, Pace Claire
Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, New Hampshire.
J Adv Pract Oncol. 2019 Jul;10(5):461-468. doi: 10.6004/jadpro.2019.10.5.4. Epub 2019 Jul 1.
Research has demonstrated that cancer survivors who receive a survivorship care plan (SCP) have better coordinated follow-up care, higher overall satisfaction, and report significantly fewer posttreatment emotional concerns. The Commission on Cancer, a program of the American College of Surgeons, has developed a standard of care in which 100% of eligible patients are to receive an SCP by the end of 2019. Nurse practitioners at a National Cancer Institute (NCI)-designated academic medical center worked to develop a standardized process to deliver SCPs to all eligible patients. The primary objective of the project was to standardize how SCPs were completed and embed them into the electronic medical record (EMR) using a templated note created for the EMR. Through an interdisciplinary steering committee, survivorship priorities were established and aligned with LIVE and American Society of Clinical Oncology guidelines. In addition, survivorship care planning was identified as an essential service to be provided by all cancer disease management groups (DMG) at the cancer center. A cancer SCP subcommittee was formed to explore methods to expand the delivery of SCPs and standardize the SCP process. Prior to this project, SCPs were being done by less than 10% of the providers and only for a few diagnoses, and no standardized method of documentation existed prior to this quality improvement initiative. The standardization of the SCP has increased both participation of other DMGs as well as increased the rate of completion to 34%. We believe that continuous reassessment and process improvement will help us reach the Commission on Cancer goal of providing SCPs to all eligible patients.
研究表明,接受生存护理计划(SCP)的癌症幸存者后续护理协调性更好,总体满意度更高,且报告的治疗后情绪问题显著减少。美国外科医师学会的一个项目——癌症委员会制定了一项护理标准,要求到2019年底,100%的符合条件的患者都要接受SCP。一家美国国立癌症研究所(NCI)指定的学术医疗中心的执业护士致力于制定一个标准化流程,以便为所有符合条件的患者提供SCP。该项目的主要目标是规范SCP的完成方式,并使用为电子病历(EMR)创建的模板化记录将其嵌入电子病历中。通过一个跨学科指导委员会,确定了生存护理重点,并使其与LIVE和美国临床肿瘤学会的指南保持一致。此外,生存护理计划被确定为癌症中心所有癌症疾病管理小组(DMG)必须提供的一项基本服务。成立了一个癌症SCP小组委员会,以探索扩大SCP提供范围和规范SCP流程的方法。在这个项目之前,只有不到10%的医疗服务提供者实施SCP,而且只针对少数几种诊断,在这项质量改进举措之前不存在标准化的记录方法。SCP的标准化提高了其他DMG的参与度,同时将完成率提高到了34%。我们相信,持续的重新评估和流程改进将帮助我们实现癌症委员会为所有符合条件的患者提供SCP的目标。