AVAHO

Background: Concurrent care hospice allows veterans to have both disease-modifying therapy, such as chemotherapy, and hospice care. While available nationally since the VA Comprehensive End-of-Life Care Initiative 2009-2012, it has not been implemented uniformly. The palliative care team at the Minneapolis VA began to actively promote concurrent care in July of 2018. Our team includes three physicians, one nurse practitioner, social worker, hospice nurse coordinator, palliative RN, chaplain, and oncology clinical nurse specialist. We hope to share what we have learned as an interdisciplinary team and how we will continue to promote concurrent care going forward.

Results: To date, 38 patients have enrolled in concurrent care hospice through 13 hospice agencies. By chart review, we found that most patients have died (22/38 enrolled). The average length of time to death from the initial enrollment with concurrent care hospice was just over 60 days, while the average for usual hospice cancer patients is about 50 days. Two patients enrolled longer than 6 months are still living. Most patients died at home or a nursing home (19/22) while 2 died in our CLC and 1 at our inpatient hospital.

Discussion: We have identified several barriers to enrollment. Hospices have expressed concern that concurrent care is not consistent with the philosophy of hospice care and may result in withheld Medicare payments. Our hospice coordinator has invested a significant amount of time educating hospices and establishing relationships. Several agencies have declined to enroll these patients and for agencies accepting patients, the review process is more rigorous and time-consuming. Internally, our biggest partners are in oncology. We had the opportunity to present our initial data and rationale for concurrent care at a monthly oncology staff meeting. While many staff saw the benefit of adding hospice support, several physicians expressed concern that hospice patients will not receive proper medical attention for chemotherapy- related side effects. We discussed communication as the best tool to help veterans and hospice agencies understand the needs of concurrent care patients. Going forward, we hope that concurrent care becomes a normal, utilized component of best practice for our veterans.

Background: Concurrent care hospice allows veterans to have both disease-modifying therapy, such as chemotherapy, and hospice care. While available nationally since the VA Comprehensive End-of-Life Care Initiative 2009-2012, it has not been implemented uniformly. The palliative care team at the Minneapolis VA began to actively promote concurrent care in July of 2018. Our team includes three physicians, one nurse practitioner, social worker, hospice nurse coordinator, palliative RN, chaplain, and oncology clinical nurse specialist. We hope to share what we have learned as an interdisciplinary team and how we will continue to promote concurrent care going forward.

Results: To date, 38 patients have enrolled in concurrent care hospice through 13 hospice agencies. By chart review, we found that most patients have died (22/38 enrolled). The average length of time to death from the initial enrollment with concurrent care hospice was just over 60 days, while the average for usual hospice cancer patients is about 50 days. Two patients enrolled longer than 6 months are still living. Most patients died at home or a nursing home (19/22) while 2 died in our CLC and 1 at our inpatient hospital.

Discussion: We have identified several barriers to enrollment. Hospices have expressed concern that concurrent care is not consistent with the philosophy of hospice care and may result in withheld Medicare payments. Our hospice coordinator has invested a significant amount of time educating hospices and establishing relationships. Several agencies have declined to enroll these patients and for agencies accepting patients, the review process is more rigorous and time-consuming. Internally, our biggest partners are in oncology. We had the opportunity to present our initial data and rationale for concurrent care at a monthly oncology staff meeting. While many staff saw the benefit of adding hospice support, several physicians expressed concern that hospice patients will not receive proper medical attention for chemotherapy- related side effects. We discussed communication as the best tool to help veterans and hospice agencies understand the needs of concurrent care patients. Going forward, we hope that concurrent care becomes a normal, utilized component of best practice for our veterans.

Background: Concurrent care hospice allows veterans to have both disease-modifying therapy, such as chemotherapy, and hospice care. While available nationally since the VA Comprehensive End-of-Life Care Initiative 2009-2012, it has not been implemented uniformly. The palliative care team at the Minneapolis VA began to actively promote concurrent care in July of 2018. Our team includes three physicians, one nurse practitioner, social worker, hospice nurse coordinator, palliative RN, chaplain, and oncology clinical nurse specialist. We hope to share what we have learned as an interdisciplinary team and how we will continue to promote concurrent care going forward.

Results: To date, 38 patients have enrolled in concurrent care hospice through 13 hospice agencies. By chart review, we found that most patients have died (22/38 enrolled). The average length of time to death from the initial enrollment with concurrent care hospice was just over 60 days, while the average for usual hospice cancer patients is about 50 days. Two patients enrolled longer than 6 months are still living. Most patients died at home or a nursing home (19/22) while 2 died in our CLC and 1 at our inpatient hospital.

Discussion: We have identified several barriers to enrollment. Hospices have expressed concern that concurrent care is not consistent with the philosophy of hospice care and may result in withheld Medicare payments. Our hospice coordinator has invested a significant amount of time educating hospices and establishing relationships. Several agencies have declined to enroll these patients and for agencies accepting patients, the review process is more rigorous and time-consuming. Internally, our biggest partners are in oncology. We had the opportunity to present our initial data and rationale for concurrent care at a monthly oncology staff meeting. While many staff saw the benefit of adding hospice support, several physicians expressed concern that hospice patients will not receive proper medical attention for chemotherapy- related side effects. We discussed communication as the best tool to help veterans and hospice agencies understand the needs of concurrent care patients. Going forward, we hope that concurrent care becomes a normal, utilized component of best practice for our veterans.

Background: Cancer survivors face unique posttreatment issues and require ongoing follow-up care. Per Commission on Cancer (CoC) and other cancer organizations, a survivorship care plan including a treatment summary and follow-up plan is standard of care. There are significant barriers to implementation of survivorship care plans due to the resources required. Our facility lacked a process to implement survivorship care plans. A need to expand clinical experiences for oncology fellows across the care continuum was also identified.

Methods: Researched existing private sector and VA models of providing cancer survivorship care. Analyzed literature regarding the unique care needs of veteran cancer survivors. NP led model was determined to support a holistic clinical care model including post treatment assessment, education, resources, and referrals.

Intervention: The Cancer Survivorship Clinic was implemented in August 2018, staffed by an oncology nurse practitioner and medical oncology fellows. Visits are face-to-face or by phone and one hour in length. Patients receive a survivorship care plan. The clinic provider addresses post-treatment health concerns and refers patients to other services when indicated. The clinic was created utilizing existing staffing and clinic space, no additional resources were needed.

Results: There were 30 Cancer Survivorship Clinic visits completed for veterans between 8/1/18 and 5/1/19. The clinic is part of an ongoing rotation for fellows and included in their annual orientation. Implementation of a Cancer Survivorship Clinic was effective in meeting the CoC Survivorship Care Plan standard. Oncology fellow rotation in the clinic has broadened their educational experience. Upon entering practice, fellows will be better equipped to address survivorship needs.

Discussion: The clinic was created utilizing existing medical oncology resources and staffing. Medical oncology is familiar with all cancer diagnoses and can therefore serve the entire cancer population. An NP-led model supports a holistic care approach, ensuring that physical and mental/emotional needs are addressed during the clinic visit. Oncology fellows receive an opportunity to care for patients following cancer treatment, expanding their understanding of cancer care. One drawback is the lack of fellow availability at certain times of the year.

Background: Cancer survivors face unique posttreatment issues and require ongoing follow-up care. Per Commission on Cancer (CoC) and other cancer organizations, a survivorship care plan including a treatment summary and follow-up plan is standard of care. There are significant barriers to implementation of survivorship care plans due to the resources required. Our facility lacked a process to implement survivorship care plans. A need to expand clinical experiences for oncology fellows across the care continuum was also identified.

Methods: Researched existing private sector and VA models of providing cancer survivorship care. Analyzed literature regarding the unique care needs of veteran cancer survivors. NP led model was determined to support a holistic clinical care model including post treatment assessment, education, resources, and referrals.

Intervention: The Cancer Survivorship Clinic was implemented in August 2018, staffed by an oncology nurse practitioner and medical oncology fellows. Visits are face-to-face or by phone and one hour in length. Patients receive a survivorship care plan. The clinic provider addresses post-treatment health concerns and refers patients to other services when indicated. The clinic was created utilizing existing staffing and clinic space, no additional resources were needed.

Results: There were 30 Cancer Survivorship Clinic visits completed for veterans between 8/1/18 and 5/1/19. The clinic is part of an ongoing rotation for fellows and included in their annual orientation. Implementation of a Cancer Survivorship Clinic was effective in meeting the CoC Survivorship Care Plan standard. Oncology fellow rotation in the clinic has broadened their educational experience. Upon entering practice, fellows will be better equipped to address survivorship needs.

Discussion: The clinic was created utilizing existing medical oncology resources and staffing. Medical oncology is familiar with all cancer diagnoses and can therefore serve the entire cancer population. An NP-led model supports a holistic care approach, ensuring that physical and mental/emotional needs are addressed during the clinic visit. Oncology fellows receive an opportunity to care for patients following cancer treatment, expanding their understanding of cancer care. One drawback is the lack of fellow availability at certain times of the year.

Background: Cancer survivors face unique posttreatment issues and require ongoing follow-up care. Per Commission on Cancer (CoC) and other cancer organizations, a survivorship care plan including a treatment summary and follow-up plan is standard of care. There are significant barriers to implementation of survivorship care plans due to the resources required. Our facility lacked a process to implement survivorship care plans. A need to expand clinical experiences for oncology fellows across the care continuum was also identified.

Methods: Researched existing private sector and VA models of providing cancer survivorship care. Analyzed literature regarding the unique care needs of veteran cancer survivors. NP led model was determined to support a holistic clinical care model including post treatment assessment, education, resources, and referrals.

Intervention: The Cancer Survivorship Clinic was implemented in August 2018, staffed by an oncology nurse practitioner and medical oncology fellows. Visits are face-to-face or by phone and one hour in length. Patients receive a survivorship care plan. The clinic provider addresses post-treatment health concerns and refers patients to other services when indicated. The clinic was created utilizing existing staffing and clinic space, no additional resources were needed.

Results: There were 30 Cancer Survivorship Clinic visits completed for veterans between 8/1/18 and 5/1/19. The clinic is part of an ongoing rotation for fellows and included in their annual orientation. Implementation of a Cancer Survivorship Clinic was effective in meeting the CoC Survivorship Care Plan standard. Oncology fellow rotation in the clinic has broadened their educational experience. Upon entering practice, fellows will be better equipped to address survivorship needs.

Discussion: The clinic was created utilizing existing medical oncology resources and staffing. Medical oncology is familiar with all cancer diagnoses and can therefore serve the entire cancer population. An NP-led model supports a holistic care approach, ensuring that physical and mental/emotional needs are addressed during the clinic visit. Oncology fellows receive an opportunity to care for patients following cancer treatment, expanding their understanding of cancer care. One drawback is the lack of fellow availability at certain times of the year.

Introduction: Advancements in genomic profiling now allow for routine comprehensive somatic genomic alteration testing in all patients with advanced cancer. A subset of patients will have targetable genomic alterations, though the frequency of these alterations and the efficacy of the matched treatments have varied amongst published data. Several commercially available platforms exist, but the ideal method to appropriately interpret and apply this data across various clinical tumor types and disease stages is still unclear.

Methods: We obtained a list of all the next generation sequencing (NGS) panels submitted from our center to the National Precision Oncology Program (NPOP). A total of 53 patients were included in the analysis. We analyzed the most frequently altered genes, the tumor types most frequently profiled, the frequency of cases with targetable alterations, and the efficacy of the matched treatments in individual patients. We also compared the number and types of alterations reported as well as the length of reports generated by the three different commercial NGS platforms used in our cohort.

Results: A total of 19/53 (35.8%) patients had targetable alterations. Five out of 21 (23.8%) received a targeted therapy. Non-small cell lung cancer [NSCLC] (n = 14; 26%) and prostate cancer (n=9; 17%) were the most frequently profiled tumors. In the NSCLC cohort, 7/14 (50%) had targetable alterations, including two patients in whom a prior single gene test for the specific alteration [EGFR, BRAF] was negative. NGS panels produced on average 6.6-13.0 alterations per patient, and average report length ranged from 8.3-19.0 pages.

Conclusions: NGS testing has been implemented by providers across a variety of tumor types at our institution, though the number of patients receiving matched treatments is low. Reflexive serial single-gene testing in NSCLC for EGFR, ALK, ROS1, and BRAF is likely reducing the number of NGS panels sent in these patients. Two false-negative single gene tests in our small cohort suggests we are underdiagnosing driver alterations in these patients with this approach. We would suggest exploring decision support tools and provider education in order to encourage judicious and clinically meaningful use of this valuable resource.

Introduction: Advancements in genomic profiling now allow for routine comprehensive somatic genomic alteration testing in all patients with advanced cancer. A subset of patients will have targetable genomic alterations, though the frequency of these alterations and the efficacy of the matched treatments have varied amongst published data. Several commercially available platforms exist, but the ideal method to appropriately interpret and apply this data across various clinical tumor types and disease stages is still unclear.

Methods: We obtained a list of all the next generation sequencing (NGS) panels submitted from our center to the National Precision Oncology Program (NPOP). A total of 53 patients were included in the analysis. We analyzed the most frequently altered genes, the tumor types most frequently profiled, the frequency of cases with targetable alterations, and the efficacy of the matched treatments in individual patients. We also compared the number and types of alterations reported as well as the length of reports generated by the three different commercial NGS platforms used in our cohort.

Results: A total of 19/53 (35.8%) patients had targetable alterations. Five out of 21 (23.8%) received a targeted therapy. Non-small cell lung cancer [NSCLC] (n = 14; 26%) and prostate cancer (n=9; 17%) were the most frequently profiled tumors. In the NSCLC cohort, 7/14 (50%) had targetable alterations, including two patients in whom a prior single gene test for the specific alteration [EGFR, BRAF] was negative. NGS panels produced on average 6.6-13.0 alterations per patient, and average report length ranged from 8.3-19.0 pages.

Conclusions: NGS testing has been implemented by providers across a variety of tumor types at our institution, though the number of patients receiving matched treatments is low. Reflexive serial single-gene testing in NSCLC for EGFR, ALK, ROS1, and BRAF is likely reducing the number of NGS panels sent in these patients. Two false-negative single gene tests in our small cohort suggests we are underdiagnosing driver alterations in these patients with this approach. We would suggest exploring decision support tools and provider education in order to encourage judicious and clinically meaningful use of this valuable resource.

Introduction: Advancements in genomic profiling now allow for routine comprehensive somatic genomic alteration testing in all patients with advanced cancer. A subset of patients will have targetable genomic alterations, though the frequency of these alterations and the efficacy of the matched treatments have varied amongst published data. Several commercially available platforms exist, but the ideal method to appropriately interpret and apply this data across various clinical tumor types and disease stages is still unclear.

Methods: We obtained a list of all the next generation sequencing (NGS) panels submitted from our center to the National Precision Oncology Program (NPOP). A total of 53 patients were included in the analysis. We analyzed the most frequently altered genes, the tumor types most frequently profiled, the frequency of cases with targetable alterations, and the efficacy of the matched treatments in individual patients. We also compared the number and types of alterations reported as well as the length of reports generated by the three different commercial NGS platforms used in our cohort.

Results: A total of 19/53 (35.8%) patients had targetable alterations. Five out of 21 (23.8%) received a targeted therapy. Non-small cell lung cancer [NSCLC] (n = 14; 26%) and prostate cancer (n=9; 17%) were the most frequently profiled tumors. In the NSCLC cohort, 7/14 (50%) had targetable alterations, including two patients in whom a prior single gene test for the specific alteration [EGFR, BRAF] was negative. NGS panels produced on average 6.6-13.0 alterations per patient, and average report length ranged from 8.3-19.0 pages.

Conclusions: NGS testing has been implemented by providers across a variety of tumor types at our institution, though the number of patients receiving matched treatments is low. Reflexive serial single-gene testing in NSCLC for EGFR, ALK, ROS1, and BRAF is likely reducing the number of NGS panels sent in these patients. Two false-negative single gene tests in our small cohort suggests we are underdiagnosing driver alterations in these patients with this approach. We would suggest exploring decision support tools and provider education in order to encourage judicious and clinically meaningful use of this valuable resource.

Background: Prostate cancer (PCa) and lung cancer (LC) are the most common cancers among men, accounting for almost 50% of all cancer cases each year in the Veterans Health Administration (VHA).

Purpose: The objectives of this analysis were to evaluate characteristics and trends in prostate and lung cancer incidence and survival (both overall and cancerspecific) among veterans receiving care in the VHA.

Methods: Data were obtained from the VA Central Cancer Registry for patients diagnosed with prostate or lung cancer. Vital status was obtained from the VA Corporate Data Warehouse and cause of death from the National Death Index. Age-adjusted incidence rates were calculated for patients diagnosed 2005-2014. Rates were based on U.S. 2010 adult population estimates and VHA user population in each fiscal year. All incidence rates are per 100,000 person-years. Fiveyear survival was estimated using the Kaplan-Meier method for patients diagnosed 2002-2012.

Results: For PCa, the age-adjusted incidence 2005- 2014 was 133, with an overall decrease ranging from 161 in 2007 to 94 in 2014. The median age at PCa diagnosis was 65 years, and approximately 86% of patients were diagnosed with clinical stage I/II disease. Five-year overall and PCa-specific survival were 80% and 95%, respectively. Between 2002-2012, overall survival increased from 74% to 82% and PCa-specific survival increased slightly from 93.1% to 94.4%. For LC, the age-adjusted incidence 2005-2014 was 77, with an overall decrease ranging from 88 in 2009 to 62 in 2014. Among males, incidence was 78 and median age at diagnosis was 68 years; corresponding incidence and age among females was 55 and 62 years. Five-year overall survival improved from 10% for 2002 diagnoses to 15% for 2012 diagnoses; similarly, LC-specific survival increased from 16% to 35% during this time.

Implications: Incidence and survival rates for lung and prostate cancer have improved over time in both in VHA, as well as non-veteran specific populations such as the SEER cancer registry, mostly due to advances in cancer detection and treatment options. Evaluating trends and patterns of care can help inform the increasing demand for high-quality cancer care in the VA healthcare system.

Background: Prostate cancer (PCa) and lung cancer (LC) are the most common cancers among men, accounting for almost 50% of all cancer cases each year in the Veterans Health Administration (VHA).

Purpose: The objectives of this analysis were to evaluate characteristics and trends in prostate and lung cancer incidence and survival (both overall and cancerspecific) among veterans receiving care in the VHA.

Methods: Data were obtained from the VA Central Cancer Registry for patients diagnosed with prostate or lung cancer. Vital status was obtained from the VA Corporate Data Warehouse and cause of death from the National Death Index. Age-adjusted incidence rates were calculated for patients diagnosed 2005-2014. Rates were based on U.S. 2010 adult population estimates and VHA user population in each fiscal year. All incidence rates are per 100,000 person-years. Fiveyear survival was estimated using the Kaplan-Meier method for patients diagnosed 2002-2012.

Results: For PCa, the age-adjusted incidence 2005- 2014 was 133, with an overall decrease ranging from 161 in 2007 to 94 in 2014. The median age at PCa diagnosis was 65 years, and approximately 86% of patients were diagnosed with clinical stage I/II disease. Five-year overall and PCa-specific survival were 80% and 95%, respectively. Between 2002-2012, overall survival increased from 74% to 82% and PCa-specific survival increased slightly from 93.1% to 94.4%. For LC, the age-adjusted incidence 2005-2014 was 77, with an overall decrease ranging from 88 in 2009 to 62 in 2014. Among males, incidence was 78 and median age at diagnosis was 68 years; corresponding incidence and age among females was 55 and 62 years. Five-year overall survival improved from 10% for 2002 diagnoses to 15% for 2012 diagnoses; similarly, LC-specific survival increased from 16% to 35% during this time.

Implications: Incidence and survival rates for lung and prostate cancer have improved over time in both in VHA, as well as non-veteran specific populations such as the SEER cancer registry, mostly due to advances in cancer detection and treatment options. Evaluating trends and patterns of care can help inform the increasing demand for high-quality cancer care in the VA healthcare system.

Background: Prostate cancer (PCa) and lung cancer (LC) are the most common cancers among men, accounting for almost 50% of all cancer cases each year in the Veterans Health Administration (VHA).

Purpose: The objectives of this analysis were to evaluate characteristics and trends in prostate and lung cancer incidence and survival (both overall and cancerspecific) among veterans receiving care in the VHA.

Methods: Data were obtained from the VA Central Cancer Registry for patients diagnosed with prostate or lung cancer. Vital status was obtained from the VA Corporate Data Warehouse and cause of death from the National Death Index. Age-adjusted incidence rates were calculated for patients diagnosed 2005-2014. Rates were based on U.S. 2010 adult population estimates and VHA user population in each fiscal year. All incidence rates are per 100,000 person-years. Fiveyear survival was estimated using the Kaplan-Meier method for patients diagnosed 2002-2012.

Results: For PCa, the age-adjusted incidence 2005- 2014 was 133, with an overall decrease ranging from 161 in 2007 to 94 in 2014. The median age at PCa diagnosis was 65 years, and approximately 86% of patients were diagnosed with clinical stage I/II disease. Five-year overall and PCa-specific survival were 80% and 95%, respectively. Between 2002-2012, overall survival increased from 74% to 82% and PCa-specific survival increased slightly from 93.1% to 94.4%. For LC, the age-adjusted incidence 2005-2014 was 77, with an overall decrease ranging from 88 in 2009 to 62 in 2014. Among males, incidence was 78 and median age at diagnosis was 68 years; corresponding incidence and age among females was 55 and 62 years. Five-year overall survival improved from 10% for 2002 diagnoses to 15% for 2012 diagnoses; similarly, LC-specific survival increased from 16% to 35% during this time.

Implications: Incidence and survival rates for lung and prostate cancer have improved over time in both in VHA, as well as non-veteran specific populations such as the SEER cancer registry, mostly due to advances in cancer detection and treatment options. Evaluating trends and patterns of care can help inform the increasing demand for high-quality cancer care in the VA healthcare system.

Background: Hematology/Oncology patients represent a complex population that requires timely follow- up to prevent clinical decompensation and delays in treatment. Previous reports have demonstrated that follow-up within 14 days is associated with decreased 30-day readmissions, and the magnitude of this impact is greater in higher risk patients. This project was designed to standardize the discharge process with the primary goal to reduce average time to hematology/oncology follow-up to 14 days.

Methods: Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team of hematology/oncology staff developed and implemented a standardized discharge process. Rotating resident physicians were trained through online and inperson orientation. Additional interventions included the development of a discharge checklist handout and clinical decision support tool including a note template and embedded order set. All patients discharged during the two-month period prior to and discharged after the implementation of the standardized process were reviewed. Patients who followed with hematology/oncology at another facility, enrolled in hospice, or died during admission were excluded. Follow-up appointment scheduling data and communication between inpatient and outpatient providers were reviewed. Data was analyzed using XmR statistical process control chart and Fisher’s Exact Test using GraphPad.

Results: One hundred forty-two consecutive patients were reviewed between May - August 2018 and January - April 2019. The primary endpoint of time to hematology/ oncology follow up appointment improved from a baseline average of 17 days prior to intervention to 13 days in PDSA cycles 1 and 2 and 10 days in PDSA cycle 3. The target of 14 day average time to follow up was achieved. Furthermore, the upper control limit decreased from 58 days at baseline to 21 days in PDSA cycle 3 suggesting a decrease in variation. Outpatient hematology/oncology provider co-signature to discharge summary increased from 20% to 54% after intervention (P=0.01).

Conclusion: Our quality initiative to standardize the discharge process for the hematology & oncology service decreased time to hematology/oncology follow up appointment, improved communication between inpatient and outpatient teams, and decreased process variation. Timelier follow-up for this complex patient population will prevent clinical decompensation and delays in treatment.

Background: Hematology/Oncology patients represent a complex population that requires timely follow- up to prevent clinical decompensation and delays in treatment. Previous reports have demonstrated that follow-up within 14 days is associated with decreased 30-day readmissions, and the magnitude of this impact is greater in higher risk patients. This project was designed to standardize the discharge process with the primary goal to reduce average time to hematology/oncology follow-up to 14 days.

Methods: Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team of hematology/oncology staff developed and implemented a standardized discharge process. Rotating resident physicians were trained through online and inperson orientation. Additional interventions included the development of a discharge checklist handout and clinical decision support tool including a note template and embedded order set. All patients discharged during the two-month period prior to and discharged after the implementation of the standardized process were reviewed. Patients who followed with hematology/oncology at another facility, enrolled in hospice, or died during admission were excluded. Follow-up appointment scheduling data and communication between inpatient and outpatient providers were reviewed. Data was analyzed using XmR statistical process control chart and Fisher’s Exact Test using GraphPad.

Results: One hundred forty-two consecutive patients were reviewed between May - August 2018 and January - April 2019. The primary endpoint of time to hematology/ oncology follow up appointment improved from a baseline average of 17 days prior to intervention to 13 days in PDSA cycles 1 and 2 and 10 days in PDSA cycle 3. The target of 14 day average time to follow up was achieved. Furthermore, the upper control limit decreased from 58 days at baseline to 21 days in PDSA cycle 3 suggesting a decrease in variation. Outpatient hematology/oncology provider co-signature to discharge summary increased from 20% to 54% after intervention (P=0.01).

Conclusion: Our quality initiative to standardize the discharge process for the hematology & oncology service decreased time to hematology/oncology follow up appointment, improved communication between inpatient and outpatient teams, and decreased process variation. Timelier follow-up for this complex patient population will prevent clinical decompensation and delays in treatment.

Background: Hematology/Oncology patients represent a complex population that requires timely follow- up to prevent clinical decompensation and delays in treatment. Previous reports have demonstrated that follow-up within 14 days is associated with decreased 30-day readmissions, and the magnitude of this impact is greater in higher risk patients. This project was designed to standardize the discharge process with the primary goal to reduce average time to hematology/oncology follow-up to 14 days.

Methods: Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a multidisciplinary team of hematology/oncology staff developed and implemented a standardized discharge process. Rotating resident physicians were trained through online and inperson orientation. Additional interventions included the development of a discharge checklist handout and clinical decision support tool including a note template and embedded order set. All patients discharged during the two-month period prior to and discharged after the implementation of the standardized process were reviewed. Patients who followed with hematology/oncology at another facility, enrolled in hospice, or died during admission were excluded. Follow-up appointment scheduling data and communication between inpatient and outpatient providers were reviewed. Data was analyzed using XmR statistical process control chart and Fisher’s Exact Test using GraphPad.

Results: One hundred forty-two consecutive patients were reviewed between May - August 2018 and January - April 2019. The primary endpoint of time to hematology/ oncology follow up appointment improved from a baseline average of 17 days prior to intervention to 13 days in PDSA cycles 1 and 2 and 10 days in PDSA cycle 3. The target of 14 day average time to follow up was achieved. Furthermore, the upper control limit decreased from 58 days at baseline to 21 days in PDSA cycle 3 suggesting a decrease in variation. Outpatient hematology/oncology provider co-signature to discharge summary increased from 20% to 54% after intervention (P=0.01).

Conclusion: Our quality initiative to standardize the discharge process for the hematology & oncology service decreased time to hematology/oncology follow up appointment, improved communication between inpatient and outpatient teams, and decreased process variation. Timelier follow-up for this complex patient population will prevent clinical decompensation and delays in treatment.

Purpose: The purpose of this quality improvement project was to determine barriers to cancer care in an urban, largely African-American veteran sample at the Washington DC Veterans Affairs Medical Center (DCVA). The DCVA veteran population has several characteristics associated with challenges in accessing cancer care, including a large African-American population and patients with mental health diagnoses.

Methods: Veterans completed an anonymous survey assess barriers to care as part of a larger survey examining veteran needs in cancer care. Descriptive statistics were conducted on the current responders (n = 128) with an ongoing recruitment goal of 150 survey completers.

Results indicated both logistical and psychosocial barriers, with trouble with transportation or parking (32%) and  nancial dif culties (20%) most frequently reported. Nearly half of the sample (45%, n = 55) reported having a psychiatric or mental health diagnosis. A signi cant percentage of this subsample reported that their mental health symptoms caused them to avoid or delay cancer screening (18%), stop cancer treatment (13%), or delay follow-up visits after  nishing cancer treatment (17%). Moreover, 62% of this sub-sample stated their mental health symptoms were worsened by their cancer care. The most common reported exacerbators were undergoing imaging (eg, MRI or PET scan) (35%), radiation therapy (33%), and attending follow-up visits (33%).

Conclusion: Logistical barriers are currently being addressed through expanding provider knowledge of transportation resources and opening of an expanded parking garage. Findings of transportation and parking barriers likely reflect specific construction projects at the DCVA and may not be generalizable to other settings. Further quality improvement work based on the results of this project include incorporating screening for mental health diagnoses and targeted interventions for patients identifying concerns related to mental health symptom stressors with the goal of increasing timeliness of care.

Purpose: The purpose of this quality improvement project was to determine barriers to cancer care in an urban, largely African-American veteran sample at the Washington DC Veterans Affairs Medical Center (DCVA). The DCVA veteran population has several characteristics associated with challenges in accessing cancer care, including a large African-American population and patients with mental health diagnoses.

Methods: Veterans completed an anonymous survey assess barriers to care as part of a larger survey examining veteran needs in cancer care. Descriptive statistics were conducted on the current responders (n = 128) with an ongoing recruitment goal of 150 survey completers.

Results indicated both logistical and psychosocial barriers, with trouble with transportation or parking (32%) and  nancial dif culties (20%) most frequently reported. Nearly half of the sample (45%, n = 55) reported having a psychiatric or mental health diagnosis. A signi cant percentage of this subsample reported that their mental health symptoms caused them to avoid or delay cancer screening (18%), stop cancer treatment (13%), or delay follow-up visits after  nishing cancer treatment (17%). Moreover, 62% of this sub-sample stated their mental health symptoms were worsened by their cancer care. The most common reported exacerbators were undergoing imaging (eg, MRI or PET scan) (35%), radiation therapy (33%), and attending follow-up visits (33%).

Conclusion: Logistical barriers are currently being addressed through expanding provider knowledge of transportation resources and opening of an expanded parking garage. Findings of transportation and parking barriers likely reflect specific construction projects at the DCVA and may not be generalizable to other settings. Further quality improvement work based on the results of this project include incorporating screening for mental health diagnoses and targeted interventions for patients identifying concerns related to mental health symptom stressors with the goal of increasing timeliness of care.

Purpose: The purpose of this quality improvement project was to determine barriers to cancer care in an urban, largely African-American veteran sample at the Washington DC Veterans Affairs Medical Center (DCVA). The DCVA veteran population has several characteristics associated with challenges in accessing cancer care, including a large African-American population and patients with mental health diagnoses.

Methods: Veterans completed an anonymous survey assess barriers to care as part of a larger survey examining veteran needs in cancer care. Descriptive statistics were conducted on the current responders (n = 128) with an ongoing recruitment goal of 150 survey completers.

Results indicated both logistical and psychosocial barriers, with trouble with transportation or parking (32%) and  nancial dif culties (20%) most frequently reported. Nearly half of the sample (45%, n = 55) reported having a psychiatric or mental health diagnosis. A signi cant percentage of this subsample reported that their mental health symptoms caused them to avoid or delay cancer screening (18%), stop cancer treatment (13%), or delay follow-up visits after  nishing cancer treatment (17%). Moreover, 62% of this sub-sample stated their mental health symptoms were worsened by their cancer care. The most common reported exacerbators were undergoing imaging (eg, MRI or PET scan) (35%), radiation therapy (33%), and attending follow-up visits (33%).

Conclusion: Logistical barriers are currently being addressed through expanding provider knowledge of transportation resources and opening of an expanded parking garage. Findings of transportation and parking barriers likely reflect specific construction projects at the DCVA and may not be generalizable to other settings. Further quality improvement work based on the results of this project include incorporating screening for mental health diagnoses and targeted interventions for patients identifying concerns related to mental health symptom stressors with the goal of increasing timeliness of care.