Hello, I’m Kathy Oubre. I am the CEO for Pontchartrain Cancer Center. We're a two-location, four-provider, community oncology practice in Southeast Louisiana. I am excited to share with you how our practice implemented a Quality Initiative for our patients with PV and the modifications that we made to our protocols as a result.
Quality care in oncology is multi-faceted. It entails taking a more holistic approach to the patient rather than just treating the disease. We strive to provide the best care experience, throughout the patient journey, hopefully leading to improved outcomes. Quality initiatives offer the opportunity to refine the care we already provide our patients while showing us where we can improve.
We were surprised to find that 7 of our 23 patients with PV had hematocrit levels over 45. Watch to see how we identified opportunities to improve what we were already doing for this patient population.
Hi, I’m Lacee Blady. I am an RN at Pontchartrain Cancer Center. I am the project leader for the ongoing Quality Initiative for PV.
Hi, I’m Kamie Williams, I am a hematology/oncology nurse practitioner at Pontchartrain Cancer Center. I supported Lacee as a consultant in the workflow development throughout the Quality Initiative.
A few years ago, I had listened to a presentation on Quality Initiatives in PV delivered by Incyte at a Coalition of Hematology Oncology Practices Meeting. Last summer we determined the timing was right to undertake this project. We were eager to invest the time and saw the value to patients in this type of an initiative.
Because PV is a rare cancer, the number of patients to manage didn’t seem overwhelming, but the benefit we could provide to patients might be significant.
First, we ran some reports out of Onco EMR. It quickly identified all of our possible patients with PV that might fit our objective. Then we reviewed some of their medical records to look at their lab values and treatment plan.
I created a workflow based on my understanding of the disease process and identified areas to discuss with Kamie and our physician – such as goal lab levels, how often to get the lab work done, and when to use medical intervention.
We got together and came up with acceptable time frames for each scenario. From there, it was all provider buy-in to correctly implement the workflow into our daily routine for this patient population.
My role in the project as an Advanced Practice Provider (APP) was not very time consuming. It might have taken a couple hours in total to develop the workflow for the project.
After that my time investment was mostly involved in the direct management and care of these patients, which is already a part of my current job responsibilities.
During our QI, at the beginning of each month, I would look to see if we had any PV patients coming into the clinic. If we did, I would look to see what care plan they were on and if they had two (2) elevated Hct or platelet lab values.
If so, I would send a task to the provider to ensure that the levels are improving or to alert them that they are not. If we don’t see any improvement, some other intervention may be needed – whether it’s changing the frequency of therapeutic phlebotomy or changing aspects of their care plan.
Our analysis of the data demonstrated that we were diligent at planning for appropriate patient management along with appropriately revising care plans when patients were not responding.
But, where we were lacking was in the follow-up. We instructed patients to get their labs done at more frequent intervals however, patients were not always comprehending or scheduling these labs. Then, these patients could get lost in follow up.
Involving the nurse in the QI improved ongoing follow up with these patients, because it provided another professional who was involved in care management. The nurse could contact patients who needed updated labs. The nurse could also alert providers of lab work that demonstrated unmanaged PV or inappropriate treatment response.
I was surprised to see the results. While we feel we’re doing a good job educating patients on the importance of frequent monitoring, there’s still plenty of room to improve in this department.
Initially, we identified 23 PV patients. This is only a few patients a month to manage. As a result of the QI, we have made care adjustments in about 7 patients, some multiple times.
Our patients mean the world to us, so even if it would’ve only impacted one patient, it was worth all of the time and effort put into it.
Being able to implement this initiative gave us guidelines, hallmarks and metrics to measure. Through this process we were able to identify little things that we weren't doing as well as we could have been doing, maybe a B minus, that was enlightening. The initiative also has a positive impact on our value-based care model.
We’ve continued this program at our clinic due to the great results. I learned that there’s no such thing as too many safety checks when it comes to our patients.
When this first started, I didn’t know if this system was going to be helpful because our providers already checked labs prior to every patient visit. However, we found when we changed the care plan we were lacking in the follow-up with the patients to get their labs. We integrated that into our QI workflow and it has helped us become more diligent with this specific subgroup of patients’ labs.
This QI has assisted our practice in creating a more proficient approach to PV management. By utilizing the RN for assistance in lab monitoring, we have directly affected patient outcomes. Now, we have modified our workflow and increased the frequency of lab work to every two weeks for patients who are not at target Hct levels of less than 45.
This has allowed earlier intervention for patients whose PV is considered “uncontrolled” because HCT is above 45, decreasing their risk for thrombosis and its complications and decreasing morbidity. This approach may also improve patient’s quality of life because more appropriate management could decrease overall symptom burden.
At the end of the day, if you look at your findings from the PV Quality Initiative and you are doing great, fabulous. Pat yourself on the back and keep moving. However, consider that you might actually learn something, and that may result in a better team experience for your organization and then, possibly, make a difference in someone's life. Thank you for watching.