Direct Access Screening Colonoscopy: An Innovative Approach to Increasing Colorectal Cancer Screening Rates Ana M. Bedon, MSN, APN, AGCNS-BC, CWON Advanced Practice Nurse Navigator November 5, 2016 Advocate Illinois Masonic Medical Center , Chicago, IL 1 Disclosures ▪ No disclosures 2 Objectives ▪ Discuss current practices for colorectal cancer screening guidelines ▪ Discuss barriers to screening ▪ Describe innovative approaches to screening ▪ Describe Direct Access Screening Colonoscopy (DASC) program ▪ Discuss successes and challenges of the DASC program 3 4
5 6 7 National Colorectal Roundtable ▪ Partnership of American Cancer Society and Centers for Disease Control and Prevention ▪ Coalition of public and private organizations dedicated to: ▪ reducing incidence and mortality of CRC ▪ educating organizations and the public on screening methods ▪ providing coordinated leadership and strategy of screening efforts ▪ Engage hospital systems, primary care offices, insurance companies, employers, community organizations, survivors and their families 8
▪ Blah blah 9 CRC screening modalities 10 Why Colonoscopy? ▪ Most sensitive ▪ Most specific ▪ Only test that prevents cancer ▪ Given the "Gold Standard" rating above all other screening options by: ▪ American Society for Gastrointestinal Endoscopy (ASGE) ▪ American Gastroenterological Association (AGA) ▪ American College of Gastroenterology (ACG) ▪ American Cancer Society (ACS) ▪ American College of Obstetricians and Gynecologists (ACOG) 11 12
Communication Prep Indifference Financial Insurance Fear Language Waiting times 13 14 15 Who We Are Advocate Health Care 13 Hospitals 12 acute care hospitals • 1 children’s hospital (2 campuses) • 5 level 1 trauma centers • 3 major teaching hospitals • 2 specialty hospitals • 2 Physician Groups 1,400 employed • Home Care Company Laboratory Joint Venture Over 250 Sites of Care 3.4 Million Patients Served 35,000 Associates; 10,O00 Nurses Total Revenue - $4.6B AA Rating 16
AIMMC Total Service Area (TSA) 17 Advocate Illinois Masonic Medical Center • 408-bed teaching hospital • Train 225+ residents and 560+ medical students a year • 900+ active MDs on staff – voluntary & employed – representing 43 medical specialties • One of four Level 1 Trauma Centers in Chicago 2015 By the Numbers: • Level III Neonatal Intensive Care Unit Admissions…………….14,600 Outpatient Visits…….180,000+ • Primary Stroke Center Births……………….......2,300+ Surgeries……………….. 12,200+ Emergency Visits…….44,290+ Traumas…………….…... 1,040+ 18 The Center for Advanced Care The Center for Advanced Care expands and centralizes several key outpatient services, including surgery, cancer care and digestive health. ▪ $100 million investment in our community ▪ 164,000 square feet of added space ▪ 20,000+ patients expected annually ▪ 7x more digestive health treatment space ▪ 6 state-of-the-art operating rooms ▪ 2 linear accelerators for cancer treatment 19 ▪ Extensive criteria for eligibility and rigorous application process ▪ Demonstrates commitment to delivering safe and high quality care ▪ Benchmark physician performance e.g. cecal intubation rate, adenoma detection rate ▪ Encourages opportunities to improve patient care based on data e.g adverse event tracking, patient satisfaction surveys 20
How the Direct Access Screening Colonoscopy (DASC) program was born ▪ 2015 Digestive Health “Road Show” ▪ Medical and surgical directors discovered PCP dissatisfaction regarding access time to colonoscopy (2-3 month average) ▪ Voice of the customer: patients and PCPs wanted a simple way to access this important screening ▪ Clinical Integration ▪ In 2014, the Illinois Masonic PHO missed the CI measure target for patients 50-65 years old screened for CRC by a colonoscopy. ▪ Center for Advanced Care ▪ Increased capacity in the new procedural area 21 22 Why reinvent the wheel?? 23 Why reinvent the wheel?? 24
DASC – Program Goals To accommodate healthy patients who need a screening colonoscopy, we established a program to expedite and simplify the process of scheduling colonoscopies. Goals: ▪ Reduce patient colonoscopy wait time from 2-3 months to 2-3 weeks. ▪ Increase access by allowing select patients in stable health to skip the traditional face- to-face consultation with a private gastroenterologist in his/her office. ▪ Achieve the AIMMC PHO CI measure target for CRC screening among 50-65 year olds. ▪ Provide a worry-free, fully navigated experience for patients. ▪ Create a closed loop of communication between Digestive Health providers and referring MDs (i.e. pathology). ▪ Facilitate quality growth and efficient scheduling in the Digestive Health procedural area. 25 26 What’s in it for me? GI Physicians ▪ “How is this different from my own office open access program?” ▪ Maximize their procedural block time ▪ Maximize their own office time due to decreased number of pre-procedure consultations ▪ Patients well educated regarding procedure, prep, and what to expect 27 What’s in it for me? Primary Care Providers ▪ You will get your patients screened! ▪ Timely ▪ Easy ▪ Meet your quality measures ▪ Easy access to results ▪ Nurse navigator closes the loop ▪ Nurse navigator keeps you informed ▪ This program will not replace your established referral patterns 28
What’s in it for me? Patients ▪ Save time ▪ Save copay/out of pocket expense ▪ High touch experience with nurse navigator ▪ Education ▪ Decrease barriers ▪ Prompt follow up for results or concerns ▪ Flexible scheduling ▪ Depending on insurance, can be scheduled within a week 29 Engage hospital leadership ▪ Utilizing current resources ▪ Increasing volume of procedures of GI lab ▪ Fully navigated patient experience ▪ Patient safety ▪ Patient satisfaction ▪ Achieving target quality measures ▪ Engage PCPs in service area that refer to other healthcare facilities 30 Engaging GIs ▪ Participation in program offered to all GI’s ▪ Needed to abide by program “rules” ▪ Set aside protected time for DASC patients ▪ Allow those patients to be screened and prepped by nurse navigator ▪ Provide adequate follow up on pathology results with patient and PCP ▪ Maintain open communication between private office and DASC program ▪ Maintain quality measures ▪ Inappropriate referrals would be excluded/referred to office 31 Exclusions for DASC ▪ Any GI symptoms ▪ Personal history of GI cancer ▪ Strong family history GI cancer ▪ BMI > 35 ▪ Age >70 ▪ Sleep apnea/use of CPAP ▪ Heart conditions ▪ Lung conditions ▪ Uncontrolled medical conditions ▪ Coagulopathy or use of anticoagulants ▪ Inability to consent ▪ Chronic use of anti-anxiety medications or narcotic pain medications 32
Engage GI lab staff ▪ Introduce program as an adjunct to current operations ▪ All patients would be a “complete package” ▪ Decreased workload for pre-procedure education ▪ Patient concerns should be addressed to nurse navigator directly or via GI lab manager ▪ This is not your regular open access! 33 Initial Steps Piloted DASC with a non-aligned, Advocate employed PCP office ▪ Patients from this office were referred to a competitor hospital ▪ Aligned one gastroenterology group with that office to pilot ▪ Allowed for GI provider consistency – a PCP concern ▪ Used lessons learned to refine DASC processes as we expanded ▪ Communicate, when possible, through EMR ▪ Revamped internal processes for scheduling efficiently ▪ Established tracking metrics ▪ Closing the loop re: pathology and next steps with PCPs 34 Process Map – What We Thought If patient meets Digestive Health Patient enters program criteria, RN RN navigator RN schedules communicates DASC* screens patient colonoscopy in timeline to PCP (Multiple entry points) H&P remotely 2-4 weeks After the procedure, the RN uses a RN gives prep RN ensures the RN ensures the rotating list of instructions and patient receives pathology DASC hospital/appt. follow-up report/next steps participating GIs details to the instructions/care are to fairly assign patient communicated patients to PCP 35 Process Map - Reality 36
37 38 Challenges Insurance ▪ Different payors ▪ Different plans ▪ Different rules for prior authorizations/referrals ▪ Not all GI providers accept all plans 39 Challenges Patients ▪ Confusion regarding program ▪ Who do I call if????? ▪ Level of engagement ▪ Follow up 40
Challenges GI physicians ▪ Loss of control ▪ Appropriateness of referral ▪ Developing rapport with patient 41 42 DASC by the numbers: July 2015 to October 2016 Patients referred • Included • Complete Nurse Navigated DASC ADR= 32.5% d ASGE ADR= 25% 43 Advocate Physician Partners (PHO) AIMMC Clinical Integration Rates 69% 70% Partnership with PHO director for targeted 59% outreach to patients 55% needing CRC screening 50-65 >65 44% Patients sent 40% informational letter followed by phone call 30% from nurse navigator 26% 25% Information updated as 17% needed or navigated 10% through DASC program July 2014 July 2015 July 2016 44
Recommend
More recommend
