Hospice & Palliative Medicine

Background: Commission on Care (CoC) Standard 3.3 states cancer centers need to focus initial efforts for survivorship care plan (SCP) delivery to patients treated with “curative intent and have completed active therapy (other than long term hormonal therapy).” The criteria on who is
a survivor, includes individuals with cancer from all disease sites. However, patients with metastatic disease, though survivors by some definitions, are not targeted for delivery of comprehensive care summaries and follow-up plans under CoC Standard 3.3.

Methods: The cancer committee at the John D. Dingell VAMC started working on the initial template for SCP in April 2013. The template was available in CPRS for the required survivorship care plan note by October 2013. Two nurse navigators were hired in 2014 to assist with beginning
this process. Review of eligible patients with the oncologist was done on a weekly basis. The nurse navigator then would prepare the note and meet with the patient to summarize the plan with a copy for their reference.

Our cancer committee met again in early 2015 and standard guidelines reviewed with minor adjustments made with the SCP template. Also, training was provided to designated staff of urology, surgery, and radiation oncology services regarding completion of SCP for their oncology patients. Required data elements included in the new survivorship care plans are details regarding treatment summary; contact information; diagnosis; stage of disease; surgery; chemotherapy; radiation therapy; and side effect management. Other information with the SCP includes ongoing adjuvant therapy; clinic visit schedule; cancer surveillance tests for recurrence; cancer screening tests and other periodic testing/exams related to specific diagnosis. Also, stressed with survivors is the importance of reporting any new, unusual and/or persistent symptoms need be brought to the attention of their provider.

Conclusions: The CoC states that the SCP can be completed by physicians; registered nurses; advanced practice nurses; nurse practitioners; physician assistants; and credentialed nurse navigators. As the number of cancer survivors continues to increase, the ongoing evaluation of long-term late effects of cancer treatment is important. The SCP is used to promote wellness and improve quality of life in cancer survivors.

Background: Commission on Care (CoC) Standard 3.3 states cancer centers need to focus initial efforts for survivorship care plan (SCP) delivery to patients treated with “curative intent and have completed active therapy (other than long term hormonal therapy).” The criteria on who is
a survivor, includes individuals with cancer from all disease sites. However, patients with metastatic disease, though survivors by some definitions, are not targeted for delivery of comprehensive care summaries and follow-up plans under CoC Standard 3.3.

Methods: The cancer committee at the John D. Dingell VAMC started working on the initial template for SCP in April 2013. The template was available in CPRS for the required survivorship care plan note by October 2013. Two nurse navigators were hired in 2014 to assist with beginning
this process. Review of eligible patients with the oncologist was done on a weekly basis. The nurse navigator then would prepare the note and meet with the patient to summarize the plan with a copy for their reference.

Our cancer committee met again in early 2015 and standard guidelines reviewed with minor adjustments made with the SCP template. Also, training was provided to designated staff of urology, surgery, and radiation oncology services regarding completion of SCP for their oncology patients. Required data elements included in the new survivorship care plans are details regarding treatment summary; contact information; diagnosis; stage of disease; surgery; chemotherapy; radiation therapy; and side effect management. Other information with the SCP includes ongoing adjuvant therapy; clinic visit schedule; cancer surveillance tests for recurrence; cancer screening tests and other periodic testing/exams related to specific diagnosis. Also, stressed with survivors is the importance of reporting any new, unusual and/or persistent symptoms need be brought to the attention of their provider.

Conclusions: The CoC states that the SCP can be completed by physicians; registered nurses; advanced practice nurses; nurse practitioners; physician assistants; and credentialed nurse navigators. As the number of cancer survivors continues to increase, the ongoing evaluation of long-term late effects of cancer treatment is important. The SCP is used to promote wellness and improve quality of life in cancer survivors.

Background: Commission on Care (CoC) Standard 3.3 states cancer centers need to focus initial efforts for survivorship care plan (SCP) delivery to patients treated with “curative intent and have completed active therapy (other than long term hormonal therapy).” The criteria on who is
a survivor, includes individuals with cancer from all disease sites. However, patients with metastatic disease, though survivors by some definitions, are not targeted for delivery of comprehensive care summaries and follow-up plans under CoC Standard 3.3.

Methods: The cancer committee at the John D. Dingell VAMC started working on the initial template for SCP in April 2013. The template was available in CPRS for the required survivorship care plan note by October 2013. Two nurse navigators were hired in 2014 to assist with beginning
this process. Review of eligible patients with the oncologist was done on a weekly basis. The nurse navigator then would prepare the note and meet with the patient to summarize the plan with a copy for their reference.

Our cancer committee met again in early 2015 and standard guidelines reviewed with minor adjustments made with the SCP template. Also, training was provided to designated staff of urology, surgery, and radiation oncology services regarding completion of SCP for their oncology patients. Required data elements included in the new survivorship care plans are details regarding treatment summary; contact information; diagnosis; stage of disease; surgery; chemotherapy; radiation therapy; and side effect management. Other information with the SCP includes ongoing adjuvant therapy; clinic visit schedule; cancer surveillance tests for recurrence; cancer screening tests and other periodic testing/exams related to specific diagnosis. Also, stressed with survivors is the importance of reporting any new, unusual and/or persistent symptoms need be brought to the attention of their provider.

Conclusions: The CoC states that the SCP can be completed by physicians; registered nurses; advanced practice nurses; nurse practitioners; physician assistants; and credentialed nurse navigators. As the number of cancer survivors continues to increase, the ongoing evaluation of long-term late effects of cancer treatment is important. The SCP is used to promote wellness and improve quality of life in cancer survivors.

Purpose: To provide reusable data to facilitate standardized oncology care documentation in CPRS for survivorship care plans (SCP) and other notes.

Background: SCP are guideline-recommended documents to engage patients in their post-treatment care. Creating a SCP manually by reviewing progress notes and redocumenting this information in a survivorship care plan is time consuming and tedious, which reduces completion rates and accuracy. The National Oncology Program office seeks to provide automated tools for VA facilities and providers to create SCPs that are timely, accurate, readily available and easily updated. SCPs created with structured data also allow for tracking of delivery of planned care.

Methods: Sixteen reminder note templates were developed that included SCPs for breast, colorectal, prostate, and lung cancers. Content for the SCP are based on Commission on Cancer (CoC) standards and determined by evidence-based quality measures from ASCO QOPI standards.
Each template has embedded patient data objects (health factors) that display previously entered information, eliminating the need for provider review of prior records. Updates to the SCP are accomplished by relaunching the SCP note template to import new health factor data. Health factor data were extracted from the VA Corporate Data Warehouse.

Results: All of the reminder dialogs have undergone formal usability testing. Changes were made to the reminder dialogs based upon this feedback. Several sections in the SCPs were made ‘local’ so that VA facilities can make edits, which reduces end-user data entry. The reminder dialogs were released nationally in April 2017, and their use to create SCPs has been endorsed by the CoC. As of June 2017, 2,775 health factors were generated on 458 patients,
and 58 SCPs have been completed.

Conclusions: Using patient data objects in progress notes offers a tool for oncology providers to use that can autocreate SCPs. Additional SCP are planned for H&N, liver, melanoma and hematological malignancies. Using patient data elements in CPRS identified by clinicians at the time
of care delivery allows core components of patient care to be structured and reused to greatly facilitate completion of SCPs.

Purpose: To provide reusable data to facilitate standardized oncology care documentation in CPRS for survivorship care plans (SCP) and other notes.

Background: SCP are guideline-recommended documents to engage patients in their post-treatment care. Creating a SCP manually by reviewing progress notes and redocumenting this information in a survivorship care plan is time consuming and tedious, which reduces completion rates and accuracy. The National Oncology Program office seeks to provide automated tools for VA facilities and providers to create SCPs that are timely, accurate, readily available and easily updated. SCPs created with structured data also allow for tracking of delivery of planned care.

Methods: Sixteen reminder note templates were developed that included SCPs for breast, colorectal, prostate, and lung cancers. Content for the SCP are based on Commission on Cancer (CoC) standards and determined by evidence-based quality measures from ASCO QOPI standards.
Each template has embedded patient data objects (health factors) that display previously entered information, eliminating the need for provider review of prior records. Updates to the SCP are accomplished by relaunching the SCP note template to import new health factor data. Health factor data were extracted from the VA Corporate Data Warehouse.

Results: All of the reminder dialogs have undergone formal usability testing. Changes were made to the reminder dialogs based upon this feedback. Several sections in the SCPs were made ‘local’ so that VA facilities can make edits, which reduces end-user data entry. The reminder dialogs were released nationally in April 2017, and their use to create SCPs has been endorsed by the CoC. As of June 2017, 2,775 health factors were generated on 458 patients,
and 58 SCPs have been completed.

Conclusions: Using patient data objects in progress notes offers a tool for oncology providers to use that can autocreate SCPs. Additional SCP are planned for H&N, liver, melanoma and hematological malignancies. Using patient data elements in CPRS identified by clinicians at the time
of care delivery allows core components of patient care to be structured and reused to greatly facilitate completion of SCPs.

Purpose: To provide reusable data to facilitate standardized oncology care documentation in CPRS for survivorship care plans (SCP) and other notes.

Background: SCP are guideline-recommended documents to engage patients in their post-treatment care. Creating a SCP manually by reviewing progress notes and redocumenting this information in a survivorship care plan is time consuming and tedious, which reduces completion rates and accuracy. The National Oncology Program office seeks to provide automated tools for VA facilities and providers to create SCPs that are timely, accurate, readily available and easily updated. SCPs created with structured data also allow for tracking of delivery of planned care.

Methods: Sixteen reminder note templates were developed that included SCPs for breast, colorectal, prostate, and lung cancers. Content for the SCP are based on Commission on Cancer (CoC) standards and determined by evidence-based quality measures from ASCO QOPI standards.
Each template has embedded patient data objects (health factors) that display previously entered information, eliminating the need for provider review of prior records. Updates to the SCP are accomplished by relaunching the SCP note template to import new health factor data. Health factor data were extracted from the VA Corporate Data Warehouse.

Results: All of the reminder dialogs have undergone formal usability testing. Changes were made to the reminder dialogs based upon this feedback. Several sections in the SCPs were made ‘local’ so that VA facilities can make edits, which reduces end-user data entry. The reminder dialogs were released nationally in April 2017, and their use to create SCPs has been endorsed by the CoC. As of June 2017, 2,775 health factors were generated on 458 patients,
and 58 SCPs have been completed.

Conclusions: Using patient data objects in progress notes offers a tool for oncology providers to use that can autocreate SCPs. Additional SCP are planned for H&N, liver, melanoma and hematological malignancies. Using patient data elements in CPRS identified by clinicians at the time
of care delivery allows core components of patient care to be structured and reused to greatly facilitate completion of SCPs.

Purpose: Create a custom patient navigation model and standard assessment tools that support an interdisciplinary team approach to address barriers to care for Veterans with cancer.

Background: Patient navigation is utilized throughout the country to address barriers to care in the most vulnerable of populations. A community needs assessment was conducted at the VA Puget Sound Health Care System in December 2014 to identify high-risk cohorts and facility barriers to care to drive the VA Puget Sound navigation team process. Veterans in identified cohorts thought to be at highest risk for barriers to care are enrolled in navigation services. Veterans are identified through formal consult, case finding and self-referral. The VA Puget Sound uses an interdisciplinary team approach that has been found to be successful in addressing complex barriers to cancer care. The VA Puget Sound Healthcare System Cancer Care Navigation Team (CCNT) consists of a Nurse Practitioner, Registered Nurse, Social Worker and a Medical Support Assistant who work together to fully address a wide range of physical, psychological and practical barriers to care that patients may experience throughout the cancer care continuum.

Methods: The CCNT uses standardized assessment tools, including a navigation intake form, the National Comprehensive Network (NCCN) Distress Thermometer and a functional assessment. The VA Puget Sound cancer navigation model is divided into four main processes based on the
cancer care continuum.

Results: Since initiation of the program in December of 2014, CCNT has enrolled over 1,295 patients diagnosed with cancer sites including: 291 gastrointestinal, 258 genitourinary, 199 lung, 218 head and neck, 11 brain, 137 hematologic, 58 multiple, 22 breast, 18 unknown, 13 sarcoma, 71 other and 12 gynecologic cancers. CCNT has had a significant impaired for patients enrolled in the program as evidence by reduced travel to the VA, improved access to care, decreased hospital stays and improving patient, family and provider satisfaction.

Implications: We present a unique interdisciplinary team approach to patient navigation that supports patient-centered care in addressing barriers to care for Veterans and assures timely access to cancer care.

Purpose: Create a custom patient navigation model and standard assessment tools that support an interdisciplinary team approach to address barriers to care for Veterans with cancer.

Background: Patient navigation is utilized throughout the country to address barriers to care in the most vulnerable of populations. A community needs assessment was conducted at the VA Puget Sound Health Care System in December 2014 to identify high-risk cohorts and facility barriers to care to drive the VA Puget Sound navigation team process. Veterans in identified cohorts thought to be at highest risk for barriers to care are enrolled in navigation services. Veterans are identified through formal consult, case finding and self-referral. The VA Puget Sound uses an interdisciplinary team approach that has been found to be successful in addressing complex barriers to cancer care. The VA Puget Sound Healthcare System Cancer Care Navigation Team (CCNT) consists of a Nurse Practitioner, Registered Nurse, Social Worker and a Medical Support Assistant who work together to fully address a wide range of physical, psychological and practical barriers to care that patients may experience throughout the cancer care continuum.

Methods: The CCNT uses standardized assessment tools, including a navigation intake form, the National Comprehensive Network (NCCN) Distress Thermometer and a functional assessment. The VA Puget Sound cancer navigation model is divided into four main processes based on the
cancer care continuum.

Results: Since initiation of the program in December of 2014, CCNT has enrolled over 1,295 patients diagnosed with cancer sites including: 291 gastrointestinal, 258 genitourinary, 199 lung, 218 head and neck, 11 brain, 137 hematologic, 58 multiple, 22 breast, 18 unknown, 13 sarcoma, 71 other and 12 gynecologic cancers. CCNT has had a significant impaired for patients enrolled in the program as evidence by reduced travel to the VA, improved access to care, decreased hospital stays and improving patient, family and provider satisfaction.

Implications: We present a unique interdisciplinary team approach to patient navigation that supports patient-centered care in addressing barriers to care for Veterans and assures timely access to cancer care.

Purpose: Create a custom patient navigation model and standard assessment tools that support an interdisciplinary team approach to address barriers to care for Veterans with cancer.

Background: Patient navigation is utilized throughout the country to address barriers to care in the most vulnerable of populations. A community needs assessment was conducted at the VA Puget Sound Health Care System in December 2014 to identify high-risk cohorts and facility barriers to care to drive the VA Puget Sound navigation team process. Veterans in identified cohorts thought to be at highest risk for barriers to care are enrolled in navigation services. Veterans are identified through formal consult, case finding and self-referral. The VA Puget Sound uses an interdisciplinary team approach that has been found to be successful in addressing complex barriers to cancer care. The VA Puget Sound Healthcare System Cancer Care Navigation Team (CCNT) consists of a Nurse Practitioner, Registered Nurse, Social Worker and a Medical Support Assistant who work together to fully address a wide range of physical, psychological and practical barriers to care that patients may experience throughout the cancer care continuum.

Methods: The CCNT uses standardized assessment tools, including a navigation intake form, the National Comprehensive Network (NCCN) Distress Thermometer and a functional assessment. The VA Puget Sound cancer navigation model is divided into four main processes based on the
cancer care continuum.

Results: Since initiation of the program in December of 2014, CCNT has enrolled over 1,295 patients diagnosed with cancer sites including: 291 gastrointestinal, 258 genitourinary, 199 lung, 218 head and neck, 11 brain, 137 hematologic, 58 multiple, 22 breast, 18 unknown, 13 sarcoma, 71 other and 12 gynecologic cancers. CCNT has had a significant impaired for patients enrolled in the program as evidence by reduced travel to the VA, improved access to care, decreased hospital stays and improving patient, family and provider satisfaction.

Implications: We present a unique interdisciplinary team approach to patient navigation that supports patient-centered care in addressing barriers to care for Veterans and assures timely access to cancer care.

Purpose: In patients initiating treatment with anti-CD20 antibodies (Ab), 20-60% with prior hepatitis B (HBV) infection not receiving HBV antiviral prophylaxis experience HBV reactivation—with hepatitis (33%), liver failure (13%), and death (5%). HBV reactivation is prevented with HBV antiviral therapy during and 12 months after anti-CD20 Ab therapy in patients with positive HBV surface antigen (HBsAg+) or HBV core antibody (HBcAb+). Our goal is to widely use anti-CD20 Ab order checks to increase testing and antiviral treatment to prevent HBV reactivation.

Background: Without HBV treatment in those at risk, fatal HBV reactivation affects 1 in 1,000 receiving rituximab. In a VHA analysis of 19,304 patients initiating anti-CD20 Ab (2002-14), > 60% of patients had HBV testing by 2014; 1 in 9 Veterans had either chronic (1-2% HBsAg+) or prior (9% HBcAb+) HBV, yet < 18% received HBV antiviral therapy. While information modestly affects behaviors, order checks with treatment algorithms can be > 95% effective.

Methods: Since 2015, our team has shared information widely, updated pharmacy criteria for use, and enabled HBV antiviral prescribing by all providers. To identify HBV testing or treatment omissions, we launched a Medication Use Evaluation Tracker (MUET), and programmed an anti- CD20 Ab order check that displays only if either HBV testing or treatment has not been done.

Results: Since 2014, HBV testing in patients initiating anti-CD20 Ab increased to 64-78% and HBV antiviral prophylaxis from < 18% to 44%. In November 2016, an anti-CD20 Ab order check was piloted at 3 sites and functional in CPRS with additional sites reporting favorable use. Additionally, a MUET was released for anti-CD20 Ab therapies providing an additional safety check.

Conclusions: VHA has increased HBV testing and antiviral treatment with anti-CD20 antibody initiation—yet more than half of patients remain at risk of HBV reactivation. Successfully used in up to 15 sites, programmed anti-CD20 Ab order checks highlight to providers when HBV testing
or antiviral prophylaxis is needed. Achieving broad use of this order check will increase HBV prophylaxis prescribing and decrease subsequent HBV reactivation. An anti-CD20 Ab MUET provides an additional safety check option for identifying at risk patient.

Purpose: In patients initiating treatment with anti-CD20 antibodies (Ab), 20-60% with prior hepatitis B (HBV) infection not receiving HBV antiviral prophylaxis experience HBV reactivation—with hepatitis (33%), liver failure (13%), and death (5%). HBV reactivation is prevented with HBV antiviral therapy during and 12 months after anti-CD20 Ab therapy in patients with positive HBV surface antigen (HBsAg+) or HBV core antibody (HBcAb+). Our goal is to widely use anti-CD20 Ab order checks to increase testing and antiviral treatment to prevent HBV reactivation.

Background: Without HBV treatment in those at risk, fatal HBV reactivation affects 1 in 1,000 receiving rituximab. In a VHA analysis of 19,304 patients initiating anti-CD20 Ab (2002-14), > 60% of patients had HBV testing by 2014; 1 in 9 Veterans had either chronic (1-2% HBsAg+) or prior (9% HBcAb+) HBV, yet < 18% received HBV antiviral therapy. While information modestly affects behaviors, order checks with treatment algorithms can be > 95% effective.

Methods: Since 2015, our team has shared information widely, updated pharmacy criteria for use, and enabled HBV antiviral prescribing by all providers. To identify HBV testing or treatment omissions, we launched a Medication Use Evaluation Tracker (MUET), and programmed an anti- CD20 Ab order check that displays only if either HBV testing or treatment has not been done.

Results: Since 2014, HBV testing in patients initiating anti-CD20 Ab increased to 64-78% and HBV antiviral prophylaxis from < 18% to 44%. In November 2016, an anti-CD20 Ab order check was piloted at 3 sites and functional in CPRS with additional sites reporting favorable use. Additionally, a MUET was released for anti-CD20 Ab therapies providing an additional safety check.

Conclusions: VHA has increased HBV testing and antiviral treatment with anti-CD20 antibody initiation—yet more than half of patients remain at risk of HBV reactivation. Successfully used in up to 15 sites, programmed anti-CD20 Ab order checks highlight to providers when HBV testing
or antiviral prophylaxis is needed. Achieving broad use of this order check will increase HBV prophylaxis prescribing and decrease subsequent HBV reactivation. An anti-CD20 Ab MUET provides an additional safety check option for identifying at risk patient.

Purpose: In patients initiating treatment with anti-CD20 antibodies (Ab), 20-60% with prior hepatitis B (HBV) infection not receiving HBV antiviral prophylaxis experience HBV reactivation—with hepatitis (33%), liver failure (13%), and death (5%). HBV reactivation is prevented with HBV antiviral therapy during and 12 months after anti-CD20 Ab therapy in patients with positive HBV surface antigen (HBsAg+) or HBV core antibody (HBcAb+). Our goal is to widely use anti-CD20 Ab order checks to increase testing and antiviral treatment to prevent HBV reactivation.

Background: Without HBV treatment in those at risk, fatal HBV reactivation affects 1 in 1,000 receiving rituximab. In a VHA analysis of 19,304 patients initiating anti-CD20 Ab (2002-14), > 60% of patients had HBV testing by 2014; 1 in 9 Veterans had either chronic (1-2% HBsAg+) or prior (9% HBcAb+) HBV, yet < 18% received HBV antiviral therapy. While information modestly affects behaviors, order checks with treatment algorithms can be > 95% effective.

Methods: Since 2015, our team has shared information widely, updated pharmacy criteria for use, and enabled HBV antiviral prescribing by all providers. To identify HBV testing or treatment omissions, we launched a Medication Use Evaluation Tracker (MUET), and programmed an anti- CD20 Ab order check that displays only if either HBV testing or treatment has not been done.

Results: Since 2014, HBV testing in patients initiating anti-CD20 Ab increased to 64-78% and HBV antiviral prophylaxis from < 18% to 44%. In November 2016, an anti-CD20 Ab order check was piloted at 3 sites and functional in CPRS with additional sites reporting favorable use. Additionally, a MUET was released for anti-CD20 Ab therapies providing an additional safety check.

Conclusions: VHA has increased HBV testing and antiviral treatment with anti-CD20 antibody initiation—yet more than half of patients remain at risk of HBV reactivation. Successfully used in up to 15 sites, programmed anti-CD20 Ab order checks highlight to providers when HBV testing
or antiviral prophylaxis is needed. Achieving broad use of this order check will increase HBV prophylaxis prescribing and decrease subsequent HBV reactivation. An anti-CD20 Ab MUET provides an additional safety check option for identifying at risk patient.

Purpose: The primary purpose of this quality improvement project was to measure and subsequently improve patient satisfaction with video-based telemedicine (VBT).

Background: Since April 1, 2015, the majority of stem cell transplant patients referred to the Tennessee Valley Healthcare System from throughout the United States were evaluated using VBT. Reduction in time to evaluation and overall cost savings have been well documented. However, we have never evaluated patient satisfaction with the VBT process.

Methods: We conducted a retrospective record review and determined that (n = 31) patients were evaluated during FY 2016. We found that (n = 16) patients were deceased, and (n = 4) patients were critically ill and unable to complete the survey. We developed and mailed a 12 question anonymous survey, to the remaining (n = 111). Veterans evaluated using VBT during the selected time frame. Questions were framed with a standard Likert scale from 1-4, with 4 being excellent and 1 being poor. We considered a score greater than 3.5 to translate to a high level of satisfaction. A ranking of less than 2.5
was equated with low satisfaction. Surveys were mailed to the patient’s address as listed in CPRS on March 6, 2017 and collected through April 10, 2017. We collected demographic and disease data on all patients surveyed.

Data Analysis: There was a 62.1% response rate (n = 69) in terms of surveys returned within the specified time frame. We tabulated average patient satisfaction data based on numeric responses to each question. We calculated demographic data including age, sex, disease, mileage from the patient’s VA to transplant center.

Results: Overall rating of care during the VBT evaluation was very good at 92.5% (3.7) with no category rated less than 3.4 (85%). Average age of the patient in the sample was 61.45 years, predominately male (n = 106), most prevalent disease was multiple myeloma (n = 53) average distance from transplant center; 559 miles. Total round-trip mileage saved by VBT 124,278 miles.

Conclusions: Patients have a high degree of satisfaction with VBT in the pre transplant evaluation setting.

Purpose: The primary purpose of this quality improvement project was to measure and subsequently improve patient satisfaction with video-based telemedicine (VBT).

Background: Since April 1, 2015, the majority of stem cell transplant patients referred to the Tennessee Valley Healthcare System from throughout the United States were evaluated using VBT. Reduction in time to evaluation and overall cost savings have been well documented. However, we have never evaluated patient satisfaction with the VBT process.

Methods: We conducted a retrospective record review and determined that (n = 31) patients were evaluated during FY 2016. We found that (n = 16) patients were deceased, and (n = 4) patients were critically ill and unable to complete the survey. We developed and mailed a 12 question anonymous survey, to the remaining (n = 111). Veterans evaluated using VBT during the selected time frame. Questions were framed with a standard Likert scale from 1-4, with 4 being excellent and 1 being poor. We considered a score greater than 3.5 to translate to a high level of satisfaction. A ranking of less than 2.5
was equated with low satisfaction. Surveys were mailed to the patient’s address as listed in CPRS on March 6, 2017 and collected through April 10, 2017. We collected demographic and disease data on all patients surveyed.

Data Analysis: There was a 62.1% response rate (n = 69) in terms of surveys returned within the specified time frame. We tabulated average patient satisfaction data based on numeric responses to each question. We calculated demographic data including age, sex, disease, mileage from the patient’s VA to transplant center.

Results: Overall rating of care during the VBT evaluation was very good at 92.5% (3.7) with no category rated less than 3.4 (85%). Average age of the patient in the sample was 61.45 years, predominately male (n = 106), most prevalent disease was multiple myeloma (n = 53) average distance from transplant center; 559 miles. Total round-trip mileage saved by VBT 124,278 miles.

Conclusions: Patients have a high degree of satisfaction with VBT in the pre transplant evaluation setting.

Purpose: The primary purpose of this quality improvement project was to measure and subsequently improve patient satisfaction with video-based telemedicine (VBT).

Background: Since April 1, 2015, the majority of stem cell transplant patients referred to the Tennessee Valley Healthcare System from throughout the United States were evaluated using VBT. Reduction in time to evaluation and overall cost savings have been well documented. However, we have never evaluated patient satisfaction with the VBT process.

Methods: We conducted a retrospective record review and determined that (n = 31) patients were evaluated during FY 2016. We found that (n = 16) patients were deceased, and (n = 4) patients were critically ill and unable to complete the survey. We developed and mailed a 12 question anonymous survey, to the remaining (n = 111). Veterans evaluated using VBT during the selected time frame. Questions were framed with a standard Likert scale from 1-4, with 4 being excellent and 1 being poor. We considered a score greater than 3.5 to translate to a high level of satisfaction. A ranking of less than 2.5
was equated with low satisfaction. Surveys were mailed to the patient’s address as listed in CPRS on March 6, 2017 and collected through April 10, 2017. We collected demographic and disease data on all patients surveyed.

Data Analysis: There was a 62.1% response rate (n = 69) in terms of surveys returned within the specified time frame. We tabulated average patient satisfaction data based on numeric responses to each question. We calculated demographic data including age, sex, disease, mileage from the patient’s VA to transplant center.

Results: Overall rating of care during the VBT evaluation was very good at 92.5% (3.7) with no category rated less than 3.4 (85%). Average age of the patient in the sample was 61.45 years, predominately male (n = 106), most prevalent disease was multiple myeloma (n = 53) average distance from transplant center; 559 miles. Total round-trip mileage saved by VBT 124,278 miles.

Conclusions: Patients have a high degree of satisfaction with VBT in the pre transplant evaluation setting.

Purpose: To improve access to specialty care for Veterans with a cancer concern and to improve communication among providers.

Background: Providers at the Cleveland VA Medical Center (CVAMC) voiced concerns that the process for Veterans with a cancer concern was fragmented, leading to potential delays in cancer diagnosis. The CVAMC developed an innovative process for the Cancer Fast Track Econsult (CFTE-C) to assist providers with expediting care for Veterans with a cancer concern. This process aims to improve communication between primary and specialty care providers, expedite pre-cancer workups, and allow more meaningful face to face first oncology specialty visits.

Methods: The E-consult is initiated by a primary care provider (PCP) in CPRS. After entering the CFTE-C an oncologist triages the consult to determine workup needed. The care coordinator (CC) ensures implementation of the plan of care and tracks its progression. This is done by the CC entering each Veteran into the Task Tracker (TT), a smart calendar that is used for communication and seamless coordination for selected Veterans. The CC continuously monitors the progression of diagnostic testing to ensure timeliness and identify delays. During the diagnostic process, the CC communicates the process to the PCP in CPRS. After cancer is confirmed or ruled out the CC discusses treatment plan with oncologist, documents in CPRS and notifies PCP.

Results: Since July 2015 there have been a total 145 veterans that have been referred to the CFTE-C. The average time from consultation to first action is 3 days. There is an average of about 6 CFTE-C consults monthly.

Implications: The CFTE-C process of using the TT allows the CC to monitor the Veterans workup and identify delays and barriers to care. The CC assists in eliminating any barriers or delays identified. The CFTE-C is underutilized by PCP’s and efforts are underway to improving utilization
by identifying a PCP champion in the outpatient clinics. There is also a need for clear measures of timeliness of care. Templated notes are in production to allow for clear tracking of the entire process including a clear handoff to PCP or referring provider.

Purpose: To improve access to specialty care for Veterans with a cancer concern and to improve communication among providers.

Background: Providers at the Cleveland VA Medical Center (CVAMC) voiced concerns that the process for Veterans with a cancer concern was fragmented, leading to potential delays in cancer diagnosis. The CVAMC developed an innovative process for the Cancer Fast Track Econsult (CFTE-C) to assist providers with expediting care for Veterans with a cancer concern. This process aims to improve communication between primary and specialty care providers, expedite pre-cancer workups, and allow more meaningful face to face first oncology specialty visits.

Methods: The E-consult is initiated by a primary care provider (PCP) in CPRS. After entering the CFTE-C an oncologist triages the consult to determine workup needed. The care coordinator (CC) ensures implementation of the plan of care and tracks its progression. This is done by the CC entering each Veteran into the Task Tracker (TT), a smart calendar that is used for communication and seamless coordination for selected Veterans. The CC continuously monitors the progression of diagnostic testing to ensure timeliness and identify delays. During the diagnostic process, the CC communicates the process to the PCP in CPRS. After cancer is confirmed or ruled out the CC discusses treatment plan with oncologist, documents in CPRS and notifies PCP.

Results: Since July 2015 there have been a total 145 veterans that have been referred to the CFTE-C. The average time from consultation to first action is 3 days. There is an average of about 6 CFTE-C consults monthly.

Implications: The CFTE-C process of using the TT allows the CC to monitor the Veterans workup and identify delays and barriers to care. The CC assists in eliminating any barriers or delays identified. The CFTE-C is underutilized by PCP’s and efforts are underway to improving utilization
by identifying a PCP champion in the outpatient clinics. There is also a need for clear measures of timeliness of care. Templated notes are in production to allow for clear tracking of the entire process including a clear handoff to PCP or referring provider.

Purpose: To improve access to specialty care for Veterans with a cancer concern and to improve communication among providers.

Background: Providers at the Cleveland VA Medical Center (CVAMC) voiced concerns that the process for Veterans with a cancer concern was fragmented, leading to potential delays in cancer diagnosis. The CVAMC developed an innovative process for the Cancer Fast Track Econsult (CFTE-C) to assist providers with expediting care for Veterans with a cancer concern. This process aims to improve communication between primary and specialty care providers, expedite pre-cancer workups, and allow more meaningful face to face first oncology specialty visits.

Methods: The E-consult is initiated by a primary care provider (PCP) in CPRS. After entering the CFTE-C an oncologist triages the consult to determine workup needed. The care coordinator (CC) ensures implementation of the plan of care and tracks its progression. This is done by the CC entering each Veteran into the Task Tracker (TT), a smart calendar that is used for communication and seamless coordination for selected Veterans. The CC continuously monitors the progression of diagnostic testing to ensure timeliness and identify delays. During the diagnostic process, the CC communicates the process to the PCP in CPRS. After cancer is confirmed or ruled out the CC discusses treatment plan with oncologist, documents in CPRS and notifies PCP.

Results: Since July 2015 there have been a total 145 veterans that have been referred to the CFTE-C. The average time from consultation to first action is 3 days. There is an average of about 6 CFTE-C consults monthly.

Implications: The CFTE-C process of using the TT allows the CC to monitor the Veterans workup and identify delays and barriers to care. The CC assists in eliminating any barriers or delays identified. The CFTE-C is underutilized by PCP’s and efforts are underway to improving utilization
by identifying a PCP champion in the outpatient clinics. There is also a need for clear measures of timeliness of care. Templated notes are in production to allow for clear tracking of the entire process including a clear handoff to PCP or referring provider.

Purpose: Palliative care is essential to oncology. This abstract describes the AVAHO Palliative Care Research Committee, its objectives, and ongoing projects that highlight the committee’s productive multidisciplinary and interinstitutional collaboration.

Background: The American Society of Clinical Oncology recommends palliative care for patients with metastatic lung cancer and other symptomatic advanced malignancies. VA mandates inpatient palliative care services for all medical facilities. However, it is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. In addition, questions remain regarding the optimal way(s) to provide palliative oncology care. Established in 2015, the AVAHO Palliative Care Research Committee currently has over a dozen members from different VA institutions. The Committee’s mission is to develop partnerships among clinicians, pharmacists, social workers, researchers, and VA leadership with the shared goal of providing optimal palliative oncology care within the VA.

Methods: Last year, we identified 2 initial approaches to address these questions, and this year we will report on our progress. First, we submitted a proposal to the VA Evidence-Based Synthesis Program (ESP) to review the evidence regarding optimal palliative care delivery methods and the feasibility of providing on-site palliative care embedded into VA oncology clinics. The ESP accepted our proposal and plans to complete their review July 2017. Second, we proposed a project to assess on-site palliative care availability in VA oncology clinics. With the support of the 2017 AVAHO Research Scholarship, we are moving forward with this project to work with VA oncology providers to understand their referral patterns, available palliative care resources, and barriers to providing optimal palliative care.

Results: At the AVAHO 2017 meeting, we will review the VA ESP results on optimal palliative oncology care delivery. In addition, we will share the progress on our ongoing project to better understand VA oncologist’s referral patterns, resources, and barriers to providing optimal palliative oncology care.

Conclusions: The AVAHO Palliative Care Research Committee represents a multidisciplinary and inter-institutional collaboration with a common goal of optimizing VA palliative oncology care. This committee is a model of how AVAHO can foster productive collaborations.

Purpose: Palliative care is essential to oncology. This abstract describes the AVAHO Palliative Care Research Committee, its objectives, and ongoing projects that highlight the committee’s productive multidisciplinary and interinstitutional collaboration.

Background: The American Society of Clinical Oncology recommends palliative care for patients with metastatic lung cancer and other symptomatic advanced malignancies. VA mandates inpatient palliative care services for all medical facilities. However, it is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. In addition, questions remain regarding the optimal way(s) to provide palliative oncology care. Established in 2015, the AVAHO Palliative Care Research Committee currently has over a dozen members from different VA institutions. The Committee’s mission is to develop partnerships among clinicians, pharmacists, social workers, researchers, and VA leadership with the shared goal of providing optimal palliative oncology care within the VA.

Methods: Last year, we identified 2 initial approaches to address these questions, and this year we will report on our progress. First, we submitted a proposal to the VA Evidence-Based Synthesis Program (ESP) to review the evidence regarding optimal palliative care delivery methods and the feasibility of providing on-site palliative care embedded into VA oncology clinics. The ESP accepted our proposal and plans to complete their review July 2017. Second, we proposed a project to assess on-site palliative care availability in VA oncology clinics. With the support of the 2017 AVAHO Research Scholarship, we are moving forward with this project to work with VA oncology providers to understand their referral patterns, available palliative care resources, and barriers to providing optimal palliative care.

Results: At the AVAHO 2017 meeting, we will review the VA ESP results on optimal palliative oncology care delivery. In addition, we will share the progress on our ongoing project to better understand VA oncologist’s referral patterns, resources, and barriers to providing optimal palliative oncology care.

Conclusions: The AVAHO Palliative Care Research Committee represents a multidisciplinary and inter-institutional collaboration with a common goal of optimizing VA palliative oncology care. This committee is a model of how AVAHO can foster productive collaborations.

Purpose: Palliative care is essential to oncology. This abstract describes the AVAHO Palliative Care Research Committee, its objectives, and ongoing projects that highlight the committee’s productive multidisciplinary and interinstitutional collaboration.

Background: The American Society of Clinical Oncology recommends palliative care for patients with metastatic lung cancer and other symptomatic advanced malignancies. VA mandates inpatient palliative care services for all medical facilities. However, it is not clearly known how palliative care is integrated into standard VA outpatient oncology practice. In addition, questions remain regarding the optimal way(s) to provide palliative oncology care. Established in 2015, the AVAHO Palliative Care Research Committee currently has over a dozen members from different VA institutions. The Committee’s mission is to develop partnerships among clinicians, pharmacists, social workers, researchers, and VA leadership with the shared goal of providing optimal palliative oncology care within the VA.

Methods: Last year, we identified 2 initial approaches to address these questions, and this year we will report on our progress. First, we submitted a proposal to the VA Evidence-Based Synthesis Program (ESP) to review the evidence regarding optimal palliative care delivery methods and the feasibility of providing on-site palliative care embedded into VA oncology clinics. The ESP accepted our proposal and plans to complete their review July 2017. Second, we proposed a project to assess on-site palliative care availability in VA oncology clinics. With the support of the 2017 AVAHO Research Scholarship, we are moving forward with this project to work with VA oncology providers to understand their referral patterns, available palliative care resources, and barriers to providing optimal palliative care.

Results: At the AVAHO 2017 meeting, we will review the VA ESP results on optimal palliative oncology care delivery. In addition, we will share the progress on our ongoing project to better understand VA oncologist’s referral patterns, resources, and barriers to providing optimal palliative oncology care.

Conclusions: The AVAHO Palliative Care Research Committee represents a multidisciplinary and inter-institutional collaboration with a common goal of optimizing VA palliative oncology care. This committee is a model of how AVAHO can foster productive collaborations.

Purpose: This project was created to expand the psychosocial distress screening program at VA Palo Alto Health Care System (VAPAHCS) to explore the levels of distress experienced by Veterans’ caregivers. Caregiver distress and burden can have a far-reaching impact on patient care, health care costs, and clinical outcomes. VAPAHCS has had a procedure in place to measure Veteran cancer patient distress levels since 2013. Clinical experiences administering distress screens in our outpatient oncology clinics suggested that caregivers accompanying Veterans to appointments may be experiencing elevated levels of distress. Thus, a program evaluation project was conducted in order to measure caregiver distress and compare distress between Veterans and caregivers.

Methods: Veterans recently diagnosed with cancer were screened for distress by a psychologist, social worker, or psychology trainee during regularly scheduled oncology appointments using the National Comprehensive Cancer Network Distress Thermometer and Symptom Checklist. Beginning in January 2016, the Distress Thermometer question was also administered verbally to any caregivers present during the Veteran’s screen.

Data Analysis: Descriptive statistics were used to explore the level of distress by Veterans and caregivers. An independent samples t test was conducted to compare overall level of distress between the two groups.

Results: A total of 483 Veterans and 93 caregivers completed distress screening during the program evaluation period (January 2016-June 2017). Average level of distress for caregivers was 3.45 (0 = no distress, 10 = extreme distress). Average level of distress for caregivers was 5.09 (0 = no distress, 10 = extreme distress). T test was found to be clinically significant, t (574)= 5.19, P < .0001. 63% of caregivers were a spouse, partner, or significant other, 22% children, and 15% ‘other’.

Implications: These results indicate that caregivers endorse, on average, distress levels above the suggested cutoff for clinically significant distress (> 4), whereas Veterans are endorsing, on average, distress below the cutoff. This suggests that additional resources for caregiver distress are warranted in our clinics. Future directions include the development of additional caregiver support programs within the VAPAHCS and improved facilitation of referrals to caregiver support outside of the VAPAHCS system.

Purpose: This project was created to expand the psychosocial distress screening program at VA Palo Alto Health Care System (VAPAHCS) to explore the levels of distress experienced by Veterans’ caregivers. Caregiver distress and burden can have a far-reaching impact on patient care, health care costs, and clinical outcomes. VAPAHCS has had a procedure in place to measure Veteran cancer patient distress levels since 2013. Clinical experiences administering distress screens in our outpatient oncology clinics suggested that caregivers accompanying Veterans to appointments may be experiencing elevated levels of distress. Thus, a program evaluation project was conducted in order to measure caregiver distress and compare distress between Veterans and caregivers.

Methods: Veterans recently diagnosed with cancer were screened for distress by a psychologist, social worker, or psychology trainee during regularly scheduled oncology appointments using the National Comprehensive Cancer Network Distress Thermometer and Symptom Checklist. Beginning in January 2016, the Distress Thermometer question was also administered verbally to any caregivers present during the Veteran’s screen.

Data Analysis: Descriptive statistics were used to explore the level of distress by Veterans and caregivers. An independent samples t test was conducted to compare overall level of distress between the two groups.

Results: A total of 483 Veterans and 93 caregivers completed distress screening during the program evaluation period (January 2016-June 2017). Average level of distress for caregivers was 3.45 (0 = no distress, 10 = extreme distress). Average level of distress for caregivers was 5.09 (0 = no distress, 10 = extreme distress). T test was found to be clinically significant, t (574)= 5.19, P < .0001. 63% of caregivers were a spouse, partner, or significant other, 22% children, and 15% ‘other’.

Implications: These results indicate that caregivers endorse, on average, distress levels above the suggested cutoff for clinically significant distress (> 4), whereas Veterans are endorsing, on average, distress below the cutoff. This suggests that additional resources for caregiver distress are warranted in our clinics. Future directions include the development of additional caregiver support programs within the VAPAHCS and improved facilitation of referrals to caregiver support outside of the VAPAHCS system.

Purpose: This project was created to expand the psychosocial distress screening program at VA Palo Alto Health Care System (VAPAHCS) to explore the levels of distress experienced by Veterans’ caregivers. Caregiver distress and burden can have a far-reaching impact on patient care, health care costs, and clinical outcomes. VAPAHCS has had a procedure in place to measure Veteran cancer patient distress levels since 2013. Clinical experiences administering distress screens in our outpatient oncology clinics suggested that caregivers accompanying Veterans to appointments may be experiencing elevated levels of distress. Thus, a program evaluation project was conducted in order to measure caregiver distress and compare distress between Veterans and caregivers.

Methods: Veterans recently diagnosed with cancer were screened for distress by a psychologist, social worker, or psychology trainee during regularly scheduled oncology appointments using the National Comprehensive Cancer Network Distress Thermometer and Symptom Checklist. Beginning in January 2016, the Distress Thermometer question was also administered verbally to any caregivers present during the Veteran’s screen.

Data Analysis: Descriptive statistics were used to explore the level of distress by Veterans and caregivers. An independent samples t test was conducted to compare overall level of distress between the two groups.

Results: A total of 483 Veterans and 93 caregivers completed distress screening during the program evaluation period (January 2016-June 2017). Average level of distress for caregivers was 3.45 (0 = no distress, 10 = extreme distress). Average level of distress for caregivers was 5.09 (0 = no distress, 10 = extreme distress). T test was found to be clinically significant, t (574)= 5.19, P < .0001. 63% of caregivers were a spouse, partner, or significant other, 22% children, and 15% ‘other’.

Implications: These results indicate that caregivers endorse, on average, distress levels above the suggested cutoff for clinically significant distress (> 4), whereas Veterans are endorsing, on average, distress below the cutoff. This suggests that additional resources for caregiver distress are warranted in our clinics. Future directions include the development of additional caregiver support programs within the VAPAHCS and improved facilitation of referrals to caregiver support outside of the VAPAHCS system.

Purpose: To demonstrate our facility’s process of successful integration of hematology electronic consultations to provide patient-centered, efficient and effective outpatient specialty care.

Background: The hematology/oncology section lost a nurse practitioner in 2013. As a way to provide continued high quality and timely care to hematology patients, electronic consultation was broadly implemented within the section.

Methods: A comprehensive electronic consultation program was established as per the Specialty Care Transformation Initiative guidelines. All Hematology consults (face to face or electronic) are addressed by the section chief.

Results: Since 2012, the section has answered over 3,600 consults electronically. In 2016 there were a total of 1,160 electronic consults placed to the service. Each year since 2012 the percentage of outpatient hematology volume that is addressed by electronic consultations has increased. During 2016, 78% of outpatient hematology volume was addressed electronically. Additionally, 85% of those patients treated with electronic consultations did not require a face to face visit within the subsequent 12 months of initial electronic consultation. Based on zip code analysis of those Veterans who had electronic consultations in 2016, we estimated that there were over 1,200 hours of driving time and nearly 70,000 miles of driving distance saved.

Conclusions: Many VAMCs are using electronic consultation to provide efficient and patient-centered specialty care. Our center has quantified the impact of successful implementation and looks to share our experience with others. Additionally, during poster presentation we will provide a toolkit for implementation, to include templated consult notes for specific hematologic conditions.

Purpose: To demonstrate our facility’s process of successful integration of hematology electronic consultations to provide patient-centered, efficient and effective outpatient specialty care.

Background: The hematology/oncology section lost a nurse practitioner in 2013. As a way to provide continued high quality and timely care to hematology patients, electronic consultation was broadly implemented within the section.

Methods: A comprehensive electronic consultation program was established as per the Specialty Care Transformation Initiative guidelines. All Hematology consults (face to face or electronic) are addressed by the section chief.

Results: Since 2012, the section has answered over 3,600 consults electronically. In 2016 there were a total of 1,160 electronic consults placed to the service. Each year since 2012 the percentage of outpatient hematology volume that is addressed by electronic consultations has increased. During 2016, 78% of outpatient hematology volume was addressed electronically. Additionally, 85% of those patients treated with electronic consultations did not require a face to face visit within the subsequent 12 months of initial electronic consultation. Based on zip code analysis of those Veterans who had electronic consultations in 2016, we estimated that there were over 1,200 hours of driving time and nearly 70,000 miles of driving distance saved.

Conclusions: Many VAMCs are using electronic consultation to provide efficient and patient-centered specialty care. Our center has quantified the impact of successful implementation and looks to share our experience with others. Additionally, during poster presentation we will provide a toolkit for implementation, to include templated consult notes for specific hematologic conditions.

Purpose: To demonstrate our facility’s process of successful integration of hematology electronic consultations to provide patient-centered, efficient and effective outpatient specialty care.

Background: The hematology/oncology section lost a nurse practitioner in 2013. As a way to provide continued high quality and timely care to hematology patients, electronic consultation was broadly implemented within the section.

Methods: A comprehensive electronic consultation program was established as per the Specialty Care Transformation Initiative guidelines. All Hematology consults (face to face or electronic) are addressed by the section chief.

Results: Since 2012, the section has answered over 3,600 consults electronically. In 2016 there were a total of 1,160 electronic consults placed to the service. Each year since 2012 the percentage of outpatient hematology volume that is addressed by electronic consultations has increased. During 2016, 78% of outpatient hematology volume was addressed electronically. Additionally, 85% of those patients treated with electronic consultations did not require a face to face visit within the subsequent 12 months of initial electronic consultation. Based on zip code analysis of those Veterans who had electronic consultations in 2016, we estimated that there were over 1,200 hours of driving time and nearly 70,000 miles of driving distance saved.

Conclusions: Many VAMCs are using electronic consultation to provide efficient and patient-centered specialty care. Our center has quantified the impact of successful implementation and looks to share our experience with others. Additionally, during poster presentation we will provide a toolkit for implementation, to include templated consult notes for specific hematologic conditions.