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Comprehensive Thoracic Oncology Program: COG Update CTOP Research Retreat David Nalepinski Director, Oncology Service Line & Business Operations May 23, 2014 Conflict of Interest I, David Nalepinski, have no conflict of interests related to the material presented within this presentation. Objectives: The “Cancer Oncology Group” Defining the Grey Zone Aligning Priorities CTOP Metrics Next Steps The Patient at the Center… A couple of definitions…. Clinical Microsystem: “a small group of people who work together in a defined setting on a regular basis to provide care and the individuals who receive that care” Surgery, HemOnc, RadOnc…. Organized by subspecialties, sections and “cost centers” Clinical Mesosystem: Connect microsystems, Surround microsystems.. Can HELP… or can HINDER microsystems The Cancer Oncology Group (COG) is a mesosystem made up of microsystems Source: Value by Design: Developing Clinical Microsystems to Achieve Organizational Excellence The Patient at the Center… Referring Providers/ Primary Care • • Prevention/Education/Pop Health Screening Referral Nutrition/Rehab/Palliative Research/Clinical Trials Radiology Pathology Navigation/Care-Management Supportive Services Treatment Modality Surgery Treatment Modality Chemotherapy Treatment Modality Radiation Treatment Support Survivorship Referring Providers/ Primary Care VARIOUS SECTIONS /DEPTS Oncology F/U ANCILLARY SERVICES SECTION RESOURCES DOS MICROSYSTEM SECTION RESOURCES RADONC MICROSYSTEM CTOP MESO-SYSTEM Tumor Board HEMONC MICROSYSTEM SECTION RESOURCES Diagnosis THINK PROGRESSION/HORIZONTAL/LONGITUDINAL Organization Vision – Market/Geopolitical System Incentives: ACO, Quality/Cost, Capitation Incentives: Episodes, FFS, wRVU’s, Cost/Unit CTOP MESOSYSTEM COG (Mesosystem) Successes!! Tumor boards Clinical trials Interdisciplinary clinics Some pathway development Patient focused providers and staff Clear “financial impact” picture Strong Q/S program Concepts on the Cancer Center strategic plan CTOP COG Metrics…. Lung Financial Trends…. Lung Financial Trends…. Lung Financial Trends…. Esophagus Financial Trends…. Esophagus Financial Trends…. Esophagus Financial Trends…. New Lung Cancer Patients New Lung Cancer Patients New Lung Cancer Patients New Esophagus Cancer Patients New Esophagus Cancer Patients New Esophagus Cancer Patients Lung Cancer Referrals (w/ Upper Valley) Lung Cancer Referrals (w/o Upper Valley) Esophagus Cancer Referrals (w/ Upper Valley) Esophagus Cancer Referrals (w/o Upper Valley) Next Steps… Oncology Service Line Development Disease based Multidisciplinary membership Medical Director who is willing and able to establish the mission, goals, processes and procedures necessary to optimize the group/program in the areas of patient care, research, and education Accountability to the Meso-System… the COG : Norris Cotton Cancer Center Clinical Organization Structure Surgery Chair NCCC Steering Committee Medicine Chair Vice President Center Director Chief Radiation Oncology Chief(s) Hematology Oncology Center Deputy Director Nursing Director NCI-CCSG Admin Director Chair Pathology Chair Radiology NCI Cancer Center Support Grant Clinical Cancer Committee Clinical Care Team Breast Surgery Endocrine GI Colon/Liver/Pancreas GU Kidney/Prostate Bladder/Testis GYN Head & Neck Lymphoma Cutaneous Lymphoma Patient Conferences (Tumor Boards) Hematology Pharmacy Radiation Care Pathways Radiology Melanoma Pathology Neuro Pediatric Thoracic Interdisciplinary Clinics Nursing Esophagus/Lung BMT Spine Care Management Care Coordination Palliation Translational Research Thyroid/Pituitary Clinical Research Cancer Oncology Group Directors Comprehensive Patient & Family Centered Care: Elements of Integrated & Coordinated Care Referral Suspected Diagnosis Patient Intake Patient Conference (Tumor Board) Interdisciplinary Clinic Cancer Oncology Group(s) Patient Navigation Care Pathway Decisions Clinical Diagnosis Treatment Schedule Coordination Treatment Modalities “Mini” Patient Care Conference(s) Shared Decision Care Management/Supportive Services/Palliation & EOL Clinical Research Education Measurement: Quality and Safety Measurement: Financial & Volume(s) Survivorship Electronic Medical Record (eDH)