Problem: With improved treatment modalities, cancer has become a chronic disease. However, without appropriate surveillance Veteran outcomes fall short of expected survival rates.
Extended longevity increases the likelihood of recurrence. The potential for development of secondary diseases or other iatrogenic disorders caused by cancer treatments also increases over time. Therefore, appropriate surveillance remains essential for detection of early complications: improving Veterans outcomes and value.
Background: Commission on Cancer accreditation requires provision of a survivorship care plan (SCP): retroactive disease and treatment information abstracted from the medical record provided at the end of treatment. The intent aims to increase communication of care as patients transition from oncology specialists. However, waiting until the completion of care fails to provide value for our Veteran or improve quality outcomes during the cancer treatment trajectory and active surveillance phase.
Our Veteran population remains stoic, ignoring symptoms requiring medical attention until symptoms become unbearable. By this time, disease progression is usually advanced. Veterans present to the emergency room in late stages of disease requiring emergent surgeries or chemotherapeutic treatments. Regrettably, such costly interventions lack extended value and only serve to stabilize or palliate symptoms: leading to poor overall Veteran outcomes and litigation liabilities for the facility.
Methods: The New Mexico VAHCS process remains different: a proactive approach, beginning at diagnosis. Imbedded health factors in the SCP, capture the provider’s individualized plan for each Veteran: identifying when surveillance care is due. Utilizing technology, the Central Data Warehouse captures this plan and populates the Cancer Dashboard. Previously, monitoring such plans remained tedious: relying on Excel spreadsheets. However, the creation of the Dashboard allows proactive identification of Veterans needing care.
Results: This system has enabled trusting relationships with our Veterans. Since implementation, the no-show rate of Veterans living with cancer has decreased from 53% to 0.09%: enabling timely care.
Conclusions: The use of health factors in proactive formats improves quality care and provides data: offering information to monitor quality metrics and establish benchmarks: improving the delivery of evidence-based care. Automation prevents loss to follow-up, decreases duplication of services, prevents omissions, and delivery of unnecessary care.
