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#Post#: 66--------------------------------------------------
Implementation details for Stratified Cancer pathways initiative
?
By: admini5 Date: May 11, 2015, 4:48 am
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[center]What are the implementation details for Stratified
Cancer pathways initiative?[/center]
The initiative was tested for 4 pathways: breast, colorectal,
lung and prostate cancer, across 14 sites. Some sites tested
more than 1 pathway.
For each pathway
With the support of NHS Improvement, current pathways were
mapped to identify the different routes patients may take from
diagnosis and treatment decisions to specialist support and
aftercare. Baseline data were gathered around referral numbers
and patient flow through the pathways.
A patient experience survey was undertaken to identify the main
issues for patients, in order to improve the information and
support offered to different groups. For breast cancer patients
the main issues identified were fatigue, fear of recurrence and
recognising signs and symptoms of recurrence; for colorectal
cancer they were bowel and urinary problems, erectile
dysfunction and sexual issues, and signs and symptoms of
recurrence; for lung cancer they were weight loss, fatigue and
breathlessness, and financial problems; and for prostate cancer
they were the signs and symptoms of recurrence, erectile
dysfunction and continence management.
Patient education events or wellbeing clinics were established
for patients in all pathways. The format varied according to
local needs and resources, but all aimed to provide patients
with more information based on the issues previously identified.
Charities specific to the tumour groups were engaged from the
start of the programme and there are examples of joint
initiatives arising from this work − for example, the
Beating Bowel Cancer: Moving On survivorship booklet and input
to the video clips on FAQs on their website. Leading charity
representatives attended workshop events to work with and advise
teams.
For all pathways holistic needs assessments were implemented.
These built on previous assessments and focused on a patient’s
medical, psychological, social, spiritual, and financial and
information needs following treatment.
Patients and clinicians then jointly developed care plans and
treatment summaries based on the patients’ identified needs.
This informed the process of stratification, in which patients
were stratified into supported self-management, shared care or
complex case management, corresponding to low, medium and high
levels of specialist support.
The stratification decision depended on a number of elements
including:
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Patients can move between the different levels of care as their
needs and the degree of dependency change.
The test work established that for lung cancer all patients
required some form of professional-led care but several could
self-manage for periods of the pathway and could be supported by
telephone assessment during this period.
The treatment summary provides a useful tool for patients and
GPs to understand the disease stage, what treatment the patient
received, the management plan and what to look out for in the
future.
At each test site
Following recruitment, each test site participated in briefings
and launch workshop events run by NHS Improvement, explaining
the aims and objectives of the initiative and clarifying the
expectations and deliverables over the course of the project.
Risks were identified at this stage and advice was provided.
Each team established a project steering group with stakeholder
representation to agree plans. The most successful teams
featured strong clinical champions supported by enthusiastic
nurses and an executive team.
Pathway mapping and baseline data collection were scheduled and
facilitated by NHS Improvement at each test site. Data on the
number of new referrals per annum, outpatient activity and
unplanned admissions were confirmed and trajectories identified
over the course of the test period. Progress and data were
reported monthly to NHS Improvement.
Several national workshop events were held for each phase of the
programme. These sought to share learning, solve problems and
enable networking with colleagues.
Patient involvement groups were held locally as well as by the
national team. Patients were encouraged to attend national
workshop events with their local teams.
Remote monitoring
Remote monitoring means the scheduling and monitoring of ongoing
surveillance tests without the need for a face-to-face
outpatient appointment. Remote monitoring is a critical
component of the self-managed pathway. Suitable patients are low
risk, stable patients in terms of their disease, their treatment
and its effects, and their psychological or social support
needs.
The system must provide a robust method of tracking patients and
ensuring that patients are tested as per the local follow-up
schedule and that defaults in attendance are managed
appropriately. The systems draw data from local cancer
information systems, pathology and other diagnostic systems to
enable the healthcare professional (usually a clinical nurse
specialist working under protocol) to review the test results,
take the appropriate action and arrange the next test. The
monitoring solution can be individualised to include details of
staging, diagnosis and treatment, and upper limits that would
trigger recall. The systems hold a range of standard letters for
informing patients and their GPs of the results, with
reinforcement of information on signs and symptoms to look out
for and key contact details for worries or concerns. Abnormal or
equivocal results usually trigger review at the next
multidisciplinary team meeting when a management plan is agreed.
The 3 general choices of system will be to use existing IT
system functionality, develop a bespoke solution or select an
externally developed solution. An example of the latter is the
IT solution sponsored by NHS Improvement that can be interfaced
with cancer and other diagnostic systems in any NHS
organisation. This is available to trusts via North Bristol NHS
Trust who host, support and develop the system. It is funded
through a service-level agreement (£5000 per annum) covering
support and maintenance with each participating organisation. A
similar solution is available via other system suppliers such as
Chameleon Information Management Services who own the InfoFlex
system. This is available free to InfoFlex users although some
trusts have required consultancy support from InfoFlex for
set-up and interface work. The purchase of additional user
licences may also be required.
All solutions require IT and project management resources for
set-up to ensure that both the technical and operational
arrangements are fit for purpose. Ongoing costs associated with
managing patients remotely in place of face-to-face follow-up
are negotiated locally with commissioners. A return on
investment based on released outpatient resources would normally
be expected within 1 to 2 years, but this would depend on the
system used and the scope of patients selected for the pathway.
For further information:
HTML http://arms.evidence.nhs.uk/resources/qipp/1029456/attachment
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