Qin Evelyn, Lim Sara, Essman Matthew, Howard Ileana
Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
Department of Rehabilitation Medicine, Veterans Affairs Puget Sound, Seattle, Washington, USA.
PM R. 2023 Oct;15(10):1292-1299. doi: 10.1002/pmrj.12949. Epub 2023 Mar 18.
To expand access to comprehensive rehabilitation services among veterans with cancer by increasing cancer rehabilitation referrals in a Veterans Affairs (VA) hospital.
A rapid cycle improvement approach based on the Institute of Healthcare Improvement's Model for Improvement was used to assess and optimize the cancer rehabilitation referral process. In this quality improvement project, our cancer rehabilitation workgroup developed an electronic screening tool within the VA electronic patient record system to streamline cancer rehabilitation referrals. Providers could complete an optional Cancer Rehabilitation (CaRe) Screen that consisted of 12 questions related to patient symptoms and function. If the screen was positive, a nonvisit electronic consult was automatically generated and sent to a physiatrist for review. The physiatrist would then triage patients to appropriate services including physiatry, physical therapy, occupational therapy, speech therapy, rehab psychology, and other rehabilitation services.
A total of 90 referrals were placed between 2019-2021. A total of 84% of the patients referred were male, 73% were white. The top cancer types referred were lung (27%), blood (23%), gastrointestinal (12%), and prostate (10%). There were 19 referrals in 2019, 13 in 2020, and 58 in 2021. The electronic screening tool was implemented in mid-2021. Advanced practice providers placed 48% of consults. Of the referrals placed in 2021, 13% of consults were initiated through the electronic screening tool. The most common rehabilitation-related referrals placed after initial cancer rehabilitation triage included physical therapy (n = 47, 35.1%), physiatry (n = 28, 20.9%), and occupational therapy (n = 24, 17.9%).
Implementing an electronic screening tool can streamline cancer rehabilitation referrals and increase access to cancer rehabilitation services for Veterans with cancer. Ongoing work is required to refine the referral process and educate providers and patients on the importance of cancer rehabilitation in the cancer care continuum.
通过增加退伍军人事务部（VA）医院的癌症康复转诊，扩大癌症退伍军人获得全面康复服务的机会。
采用基于医疗保健改进研究所改进模型的快速循环改进方法，对癌症康复转诊流程进行评估和优化。在这个质量改进项目中，我们的癌症康复工作组在VA电子病历系统中开发了一种电子筛查工具，以简化癌症康复转诊。医护人员可以完成一个可选的癌症康复（CaRe）筛查，该筛查由12个与患者症状和功能相关的问题组成。如果筛查呈阳性，将自动生成一个非就诊电子会诊，并发送给物理治疗师进行审核。然后，物理治疗师会将患者分诊到适当的服务，包括物理治疗、职业治疗、言语治疗、康复心理学和其他康复服务。
2019年至2021年期间共进行了90次转诊。转诊患者中84%为男性，73%为白人。转诊的主要癌症类型为肺癌（27%）、血液癌（23%）、胃肠道癌（12%）和前列腺癌（10%）。2019年有19次转诊，2020年有13次，2021年有58次。电子筛查工具于2021年年中实施。高级执业医护人员发起了48%的会诊。在2021年进行的转诊中，13%的会诊是通过电子筛查工具发起的。在最初的癌症康复分诊后，最常见的与康复相关的转诊包括物理治疗（n = 47，35.1%）、物理医学与康复（n = 28，20.9%）和职业治疗（n = 24，17.9%）。
实施电子筛查工具可以简化癌症康复转诊，并增加癌症退伍军人获得癌症康复服务的机会。需要持续开展工作，以完善转诊流程，并就癌症康复在癌症护理连续过程中的重要性对医护人员和患者进行教育。
