Cancer Care Collaborative Approach to Optimize Clinical Care
A collaboration between clinicians and industrial engineers resulted in significant improvements in cancer screening, the development of toolkits, and more efficient care for hepatocellular carcinoma and breast, colorectal, lung, head and neck, and prostate cancers.
A collaboration between clinicians and industrial engineers resulted in significant improvements in cancer screening, the development of toolkits, and more efficient care for hepatocellular carcinoma and breast, colorectal, lung, head and neck, and prostate cancers.
Cancer is one of the most common causes of premature death and disability that requires long-term follow-up surveillance and oftentimes ongoing treatment for survivors that can lead to important health, psychosocial
Like other cancer treatment systems, the VA faces some challenges in timeliness, surveillance, and quality of the cancer care process.12-18 Although implementation of cancer patientcentered home care and other efforts were developed to improve delivery and efficiency of cancer care in VA and non-VA facilities, the patient continuum of care remains convoluted.2,19-23
In 2004, the Clinical Cancer Care Collaborative (C4), a national VA program, was launched to improve timeliness, quality, access improvement, efficiency, and the “sustainability and spread” of successful programs at the VA. This program included representatives throughout the VA and encompassed cancer care coordinators (clinical nurse navigators), advisory panels, and a multidisciplinary team of clinicians.
In 2009, the VA promoted the Cancer Care Collaborative (CCC) to focus on optimizing the timeliness and quality of colorectal, breast, lung, prostate, and hematologic cancer care throughout the VA health care system. The VA Office of Systems Redesign (SR) partnered with the VA-Center for Applied Systems Engineering (VA-CASE) Veteran Engineering Resource Center (VERC), including industrial engineers (IEs) to provide their expertise and support. The CCC provided a forum to develop teams; set aims; and map, measure, analyze, and implement changes to assure timely diagnosis and initiation of evidence-based treatment and subsequently sustain the practices that led to improvements in these areas.
The CCC structure was separated into 6 distinct support areas: (1) industrial/systems engineering support; (2) informatics and clinical application support; (3) development and dissemination of improvement resource guides; (4) real-time and rapid-cycle evaluation tools and approaches; (5) application of advanced operational systems engineering techniques, such as simulation and modeling to inform further system optimization; and (6) advisory panels focused on quality topics that were identified, developed, implemented, and evaluated by the participants with support from the CCC faculty.
Here the authors describe the framework of the CCC model developed by VA-CASE, demonstrate the performance improvement results of teams focusing on several types of cancer, and highlight the key indicators to best practices.
Methods
Figure 1 outlines the CCC 3-Phase Conceptual Model. Phase 1 included diagnosis (screening and symptoms); phase 2 included treatment (from diagnosis to beyond treatment); and phase 3 was designed for hub and spoke facilities where screening/diagnosis occurs in a smaller (spoke) facility and treatment occurs in the larger (hub) facility.
In the first phase, 18 facility-based teams were selected through an application and interview process and immediately applied SR to their team’s specific improvement projects, which included the following cancers: breast, colorectal, lung, and prostate.
In addition to the cancer types covered in the initial phase, phase 2 also included hepatocellular carcinoma (HCC) and head and neck cancers. National VHA Toolkits were products that developed from and for use in lung and colorectal cancers (CRCs) (phases 1 and 2). These were organized and disseminated throughout the entire VA, offering specific knowledge and tools that could be applied to improving cancer care. The toolkit included guidance documents, specific process examples, and items that could be downloaded into Microsoft SharePoint (Redmond, WA) for adaptation and use by VA facilities. The toolkit contents were primarily developed and/or identified by CCC participants and funded by the VA Office of Quality and Performance (OQP) and SR. The toolkits included links to the following resources for each cancer type in phase 2: quality indicators, tool tables, timeliness measures, understanding the continuum of care, and a resource entitled, “How Can the Quality Metrics Help Me?” (eAppendix 1, available at fedprac.com/AVAHO).
