A new proactive virtual resource center navigation model identifies patient risk factors to reduce barriers to cancer care during the COVID-19 pandemic.

PURPOSE: The COVID-19 pandemic has exacerbated cancer treatment disparities, including accessibility to resources. We describe the process and outcomes of a new proactive, virtual nurse-led, resource center navigation model enhanced by using volunteer patient navigators. Using known patient risk factors, this model provides interventions to reduce barriers to care, with an emphasis on non-English-speaking populations. METHODS: Patients were included if they (1) were in active cancer treatment and (2) had one or more known risk factors: distance from cancer hospital, needing complex care, 65 years or older, malignant hematological diagnosis, new treatment start, lives alone, non-English speaker, or a new hospital discharge. Nurse navigators triaged referrals to appropriate team members who identified and addressed barriers to care. RESULTS: The program engaged with 586 adult cancer patients over 1459 encounters. The most common risk factors included distance (59.7%), complex care (48.8%), and new treatment start (43.5%). The most common interventions were core education (69.4%), emotional support (61.2%), and education (35.7%). Statistical differences were found between Spanish-speaking (n = 118) and non-Spanish-speaking patients (n = 468). While Spanish-speaking patients had fewer risk factors (1.95 vs. 2.80, p ≤ .0001), they had nearly double the number of visits (4.27 vs. 2.04, p ≤ .0001) and 69% more interventions (8.26 vs. 4.90, p ≤ .0001). Many patients (42.7%) required follow-up visits. CONCLUSION: We successfully established a new navigation model for the resource center during the pandemic that identified and reduced barriers to care, particularly in the Spanish-speaking population.

Risk stratification and outreach to hematology/oncology patients during the COVID-19 pandemic.

PURPOSE: Cancer patients have many medical and psychosocial needs, which may increase during the COVID-19 pandemic. We sought to (1) risk-stratify hematology/oncology patients using general medicine and cancer-specific methods to identify those at high risk for acute care utilization, (2) measure the correlation between two risk stratification methods, and (3) perform a telephone-based needs assessment with intervention for high-risk patients. METHODS: Patients were risk-stratified using a general medical health composite score (HCS) and a cancer-specific risk (CSR) stratification based on disease and treatment characteristics. The correlation between HCS and CSR was measured using Spearman's correlation. A multi-disciplinary team developed a focused needs assessment script with recommended interventions for patients categorized as high-risk by either method. The number of patient needs identified and referrals for services made in the first month of outreach are reported. RESULTS: A total of 1697 patients were risk-stratified, with 17% high-risk using HCS and 22% high-risk using CSR. Correlation between HCS and CSR was modest (ρ = 0.41). During the first month of the pilot, 286 patients were called for outreach with 245 contacted (86%). Commonly identified needs were financial difficulties (17%), uncontrolled symptoms (15%), and interest in advance care planning (13%), resulting in referral for supportive services for 33% of patients. CONCLUSION: There is a high burden of unmet medical and psychosocial needs in hematology/oncology patients during the COVID-19 pandemic. A telephone-based outreach program results in the identification of and intervention for these needs; however, additional cancer-specific risk models are needed to improve targeting to high-risk patients.

Monitoring collaborative practice guideline access: initial steps to define effect on patient outcomes.

Over the past decade Intermountain Healthcare (Intermountain) developed the Collaborative Practice Guidelines (CPGs) as an e resource to direct bedside care delivery. The intent was to decrease care variability and improve patient outcomes. The CPGs provide pertinent clinical knowledge at the point of care. Intermountain clinicians are responsible to deliver care based on the best level of evidence available as reflected in the CPGs. Data regarding access was requested by Intermountain leaders to begin answering the question whether the CPGs have any effect on improving patient outcomes.

The Independent Specialty Medical Advocate Model of Patient Navigation and Intermediate Health Outcomes in Newly Diagnosed Cancer Patients.

BACKGROUND: Navigation programs are generally characterized as providing patient-centered support and guidance intended to help patients and family members overcome barriers such as timely diagnosis resolution, patient satisfaction, coping with primary and adjuvant treatment, management of side effects, and patient engagement in the healthcare process. The aim of this study was to examine the associations between the Independent Specialty Medical Advocate (ISMA) model of patient navigation and intermediate patient health outcomes for newly diagnosed cancer patients. METHODS: A pre-post intervention study was conducted in 26 newly diagnosed cancer patients recruited from a national partnership between the LIVESTRONG Cancer Navigation Service Program and the NavigateCancer Foundation between April 2013 and December 2015. Participants received a 1-hour initial telephone consultation, and then a navigation care plan was developed for the 6-week study period. A paired t test was conducted to assess changes in intermediate health outcomes at baseline and 6 weeks after study intervention. RESULTS: The majority of study participants were males (62%), married (50%), and Caucasian (69%). Overall, there was a statistically significant reduction in anxiety at 6 weeks postintervention (mean, 2.48; SD, 0.62; P <.05) compared with baseline (mean, 2.92; SD, 0.82) and in depression at 6 weeks postintervention (mean, 2.00; SD, 0.81; P <.05) compared with baseline (mean, 2.45; SD, 0.19). CONCLUSION: The ISMA model of patient navigation appears to be associated with significant reduction in anxiety and depression. Further studies are needed to evaluate the ISMA model of patient navigation on long-term patient outcomes.

Linking interdisciplinary patient care standards to clinical information systems using structured actions.

Intermountain Healthcare (Intermountain) has developed and deployed a document collection of over 700 evidence-based inpatient interdisciplinary patient care standards as a means of improving patient care by reducing practice variability. We propose to identify and structure action concepts from these care standards, define their embedded work items and relative financial values, and use the coded concepts as the application development construct that enables patient workload requirement and cost prediction. Valid action concepts will conform to a compositional terminology model that details clinically meaningful information at various levels of granularity as well as the minimum required experience (e.g., licensure) and relative probable effort required for performing the action. The projected total actions that a patient requires will form the basis for workload and cost prediction.

Development of coded action concepts to support workload and cost prediction applications.

We propose to use a compositional terminology model to encode care-directive concepts or "actions" from patient care standards. Action concepts are made up of one or more work items that can be part of a work list or care plan. The nature of an action is specified by the elements of the terminology model. Actions can have implied financial value. The projected total actions that a patient requires will form the basis for workload and cost prediction.

Integration of interdisciplinary guidelines with clinical applications: Current and future scenarios.

Intermountain Healthcare (Intermountain) has developed a referential free-text interdisciplinary document collection to define standards for patient care. In order to improve access and use in bedside clinician workflow, Intermountain converted the document collection into a ubiquitous web-compatible format. The content has been structured using XML so it can be utilized by Intermountain's existing clinical applications, as well as positioning it for use in future deployed applications. It has become evident the strategy of structuring the content in this web-compatible format will support its use to drive current and future system functionality. As Intermountain moves forward in creating and deploying clinical applications, it is important to maintain and improve the current collection structure, sustaining the efficient integration and use of the content necessary to support clinician workflow and to meet information needs.

Feasibility of linking external valuation sources to bedside-caregiver activities in interdisciplinary patient care standards.

Establishing accurate and standardized values for bedside-care activities is crucial to the development of resource utilization prediction and management systems. We describe our experience of associating a representative sample of activities extracted from interdisciplinary patient care standards developed at Intermountain Healthcare with an external database of time & motion valued actions. The association exercise revealed important considerations for the development of a standard methodology for linking activities to future national or international standardized value units.

Towards ubiquitous peer review strategies to sustain and enhance a clinical knowledge management framework.

Widespread cooperation between domain experts and front-line clinicians is a key component of any successful clinical knowledge management framework. Peer review is an established form of cooperation that promotes the dissemination of new knowledge. The authors describe three peer collaboration scenarios that have been implemented using the knowledge management infrastructure available at Intermountain Healthcare. Utilization results illustrating the early adoption patterns of the proposed scenarios are presented and discussed, along with succinct descriptions of planned enhancements and future implementation efforts.

Understanding nurses' information needs and searching behaviour in acute care settings.

UNLABELLED: We report the results of a pilot study designed to describe nurses' information needs and searching behaviour in acute care settings. Several studies have indicated that nurses have unmet information needs while delivering care to patients. AIM: Identify the information needs of nurses in acute care settings. METHODS: Nurses at three hospitals were asked to use an information retrieval tool (CPG Viewer). A detailed log of their interactions with the tool was generated. RESULTS AND CONCLUSIONS: Our findings suggest that nurses' information needs are different from what is reported in the literature in terms of physicians' information needs. Questions regarding a nursing procedure or protocol were the most common needs nurses had.