Download Aptium Oncology Takes a Standardized, Hands-On

improving
value
Aptium Oncology
Takes a Standardized,
Hands-On Approach
to Managing Oncology Care
by John S. Macdonald, MD, FACP, Chief Medical Officer, Aptium Oncology Inc.
Aptium Oncology has been designing,
building, and managing cancer centers
at leading hospitals for more than
25 years. Since our first cancer center
project in the early 1980s, we’ve
been driven by the vision of building
multispecialty, multidisciplinary
environments that can provide
comprehensive care for cancer patients
in one central location. Today, we
manage leading cancer centers across
Florida, California, New York, New
Jersey and other states.
Our fundamental business model is
based on continually improving quality
by centralizing experts and resources,
standardizing care processes, and
rapidly applying research and lessons
learned at each center to the benefit
of patients at all centers. Through our
now extensive experience in this field
and the growing body of expertise we
continue to cultivate, we believe we are
able to deliver more comprehensive,
better-coordinated care for cancer
patients than many hospitals would be
able to provide on their own.
Evolution of the Cancer
Center Model
To begin, it is important to
remember how differently cancer
care was provided just a few
decades ago. In the 1970s and
early 1980s, cancer care was highly
fragmented. For example, a patient
might undergo oncologic surgery
at a local hospital but have to visit
a different hospital or freestanding
clinic to receive radiation therapy.
Typically, all individuals who
could impact patient care – such
as infectious disease physicians,
pain specialists, psychiatrists, and
social workers – were scattered
at many different facilities. For a
cancer patient, this fragmented care
model meant that getting treatment
was often a highly complex,
time-consuming, and stressful
experience. It was clear that patients
could benefit from having a single,
focused place to go where all the
people who might have an effect
on their diagnosis and care could
be present. Hence, the genesis of
cancer centers.
Several major cancer centers were
established in the 1980s; at that
time, we recognized that individual
hospitals creating their own programs
managedcareoncology.com to address care fragmentation was
not necessarily the most effective
approach. Because of this, we set
out at that time to design, develop,
implement, and manage cancer
centers so hospitals could create such
centers more quickly, effectively, and
in a standardized way. Today, we
continue this effort: developing and
managing licensed outpatient cancer
center programs for hospitals that
wish to coordinate and enhance their
cancer care.
Benefits of Improving
Cancer Centers
One of the areas that we have
focused on is improving processes
and standards of care. This can
be accomplished in several ways:
ensuring that there are experts in all
cancer fields, that we are constantly
gathering data to ensure that the care
delivered is the highest quality, and
that care is delivered according to an
evidence-based medicine approach
whenever possible.
The greatest advantage hospitals
and patients realize through this
approach, however, is the benefit of
an experienced leadership. Whenever
a hospital asks to have its cancer
program reviewed, key areas must be
benchmarked and assessed: staffing,
patient flow and patient navigation,
and outpatient cancer surgery and
radiotherapy.
In addition to operational issues,
how patient quality of life is managed
must be reviewed at each institution.
Some areas may sound trivial, but
they are very important to patients.
For example, valet parking and social
and supportive services where patients
10 managedcareoncology Summer 2009
are receiving treatment lead to overall
improvements in patient satisfaction.
More importantly, if patients
experience financial or insurance
issues, they must be connected with
resources that can help solve such
problems in real time.
Other examples of how high-quality
and efficient care can be improved
include:
■ 24-hour Infusion Centers: We
recognized early on that in certain
situations patients could benefit
from infusion centers that operated
24 hours a day, seven days a week.
For patients and insurers alike, it
may mean avoiding an emergency
room visit, because if urgent cancer
care is required the cancer center
is available for treatment. Key to
developing these infusion centers is
determining the most efficient way to
staff the facility, accurately predicting
patient load, and managing the
flow of laboratory tests back to the
infusion centers (a major cause of
delay in cancer care, as clinicians
need to have blood test results before
administering chemotherapy). When
■
the process is performed correctly, a
three-hour laboratory wait may be
reduced to 20 to 30 minutes.
Service Line Leaders: It is key to have
access to care experts. Consequently,
we staff centralized experts for each
of the functional areas of the cancer
center, such as laboratory, nursing
management, radiation therapy, and
radiology. These experts are charged
with maintaining continuity of care
and prospectively determining the
next steps needed to enhance the
quality of care. These can range
from upgrading laboratory or
managedcareoncology.com 11
■
treatment equipment to shifting
resources toward a new developing
field. Service line leaders are also
available to visit any of the cancer
centers to benchmark quality of care,
recommend ways care quality can be
improved, and identify and resolve
any problem areas.
Electronic Medical Record (EMR):
Hospitals and cancer centers around
the country are evaluating or are
in the process of implementing an
EMR. For the most part, however,
most hospitals will deploy an EMR
as an isolated implementation at
a single center. In contrast, we are
deploying an EMR systematically
across all care centers. We are beginning with a smaller-scale initial
deployment at our Desert Regional
Medical Center Comprehensive
Cancer Center in Palm Springs to
identify issues and opportunities for
enhancement. Ultimately, we will
roll out an EMR that is specific for
oncology care at all our centers. We
believe this work will lead to a specialized expertise in the development
and implementation of an oncology
program EMR. This expertise will
then be used to assist clinical information management companies
to develop and implement cancer
program EMRs more effectively.
Bringing Research to the
Aid of Patients
The other vital aspect of our model
is the integration of clinical and
translational research throughout our
network of cancer centers. Naturally, in
oncology, access to research is implicit
and very important for the delivery of
quality care. Take pancreatic cancer,
for example, where today the standard
of care results in a 5% survival rate.
For patients suffering from pancreatic
cancer and for many other cancer
12 managedcareoncology Summer 2009
patients, a well-designed, rationally
based research protocol may be an
improvement over the standard of care.
To adequately conduct cancer research,
we incorporate the space, personnel,
and resources in each of our cancer
centers into a dedicated research
office, so that clinical trials can be
performed. These offices are part of our
national research program, the Aptium
Oncology Research Network (AORN).
By managing research and clinical trials
at all our centers under the umbrella
of a single program, we gain a number
of advantages. We are able to operate
AORN as a brokerage organization
for coordinating national trials for
pharmaceutical companies. We are also
able to develop networks of expertise
in specific disease areas. For example,
one such network is the Aptium
Gastrointestinal Cancer Consortium,
through which major institutions
around the country participate in
clinical trials for gastrointestinal cancer.
We’ve found this approach to be highly
effective; it allows for easier protocol
management and faster administrative
turnaround times. Being able to
operate trials at multiple institutions
under a master contract rather
than each center having to contract
individually is an enormous benefit.
Measuring Results
Given the nature of oncology, it is
possible to gather metrics about
adherence to treatment guidelines,
but it is difficult to draw meaningful
conclusions from the measurement
of aggregate clinical outcomes.
Nonetheless, the impact of our
approach to cancer care is clearly
reflected in improved patient
satisfaction scores. We continually
measure patient satisfaction and have
published the results in which we
examined more than 17,000 patient
interactions.1 Patients are pleased with
the kind of care they receive at our
comprehensive, coordinated outpatient
centers. Our clinicians also report high
satisfaction with what we term the
“ambiance” of clinical care delivery.
Consistently, clinicians report that
they have the skilled staff, the support,
and the resources to practice medicine
the way they want to practice. We also
see those results in the relatively low
physician turnover rates in our centers,
with most physicians staying long term.
Looking Ahead
Given the uncertain regulatory
environment and the prospect of
centrally directed health system reform,
it is difficult to predict what cancer care
will look like several years down the
road. However, a few developments
seem likely, regardless of how health
system reform plays out.
We expect to see a continuing shift
of oncologists from independently
operating community practices to
multidisciplinary cancer centers. We
expect to see cancer care delivered in
an evidence-based manner, wherever
possible. Clinical guidelines are going
to be increasingly important as we work
to improve therapeutic approaches and
ensure that patients always receive the
right drugs at the right time.
As we take further steps to enhance
quality in cancer care, it makes
intuitive sense to move more and
more to cancer programs without
walls. It makes sense to bring together
all the experts in the diagnosis and
treatment of cancer for all types of
patients, and to centralize everyone
who impacts patient care in a single
location. That’s why, in the broadest
sense, we expect to see continued
strong growth in the multidisciplinary
approach to cancer care.
References
1. Wolcott DL, Wolosin RJ, and Macdonald JS. Patient
support services and patient satisfaction. Oncology Issues.
2009;24(1):42.
managedcareoncology.com 13