Ruiz J

Background: The Salisbury VA Medical Center (SVA) is a rural VA and some of our veterans with cancer are treated at VA Health Care Center (HCCs) in Kernersville or Charlotte. The VA telehealth platform provides a bridge to address dietary issues for veterans that cannot travel to Salisbury. The SVA offers virtual nutrition counseling sessions conveniently scheduled in conjunction with veterans HCC oncology visit and eliminates the need for additional appointments or having to arrange transportation to SVA.

Dietary counseling for veterans with cancer is an integral part of the SVA cancer care program. This commitment is shown by SVA Medical Centers commitment to a board certified oncology dietician FTE. The oncology dietician staffs the SVA outpatient medical oncology clinic and manages dietary issues that are present at diagnosis or arise during treatment. Annually, the oncology dietician averages a case load of 334 unique veterans and averages 1395 visits with these veterans. Most of these dietary encounters occur at the SVA infusion center while veterans are getting treatment or in the SVA oncology exam room after the veteran visits with their oncologic provider.

Methods: To provide this same dietary service to Kernersville and Charlotte veterans, the dietary oncology telehealth program was established. The program has performed 99 telehealth visits. The telehealth visits accomplish the same objectives as the live clinic appointments.

Common dietary issues that are managed in the clinic involve weight loss in lung cancer veterans, weight gain in prostate cancer veterans, and malabsorption in colorectal cancer veterans. The oncology dietician has competency and resources in managing these nutrition impact symptoms.

Implizations: Ideas for expansion of the Salisbury oncology dietary telehealth program would be to utilize the new Anywhere to Anywhere initiative, to improve access to veterans in the SVA system and to possibly aid other VAs oncology programs that do not have a dedicated oncology dietician.

Background: The Salisbury VA Medical Center (SVA) is a rural VA and some of our veterans with cancer are treated at VA Health Care Center (HCCs) in Kernersville or Charlotte. The VA telehealth platform provides a bridge to address dietary issues for veterans that cannot travel to Salisbury. The SVA offers virtual nutrition counseling sessions conveniently scheduled in conjunction with veterans HCC oncology visit and eliminates the need for additional appointments or having to arrange transportation to SVA.

Dietary counseling for veterans with cancer is an integral part of the SVA cancer care program. This commitment is shown by SVA Medical Centers commitment to a board certified oncology dietician FTE. The oncology dietician staffs the SVA outpatient medical oncology clinic and manages dietary issues that are present at diagnosis or arise during treatment. Annually, the oncology dietician averages a case load of 334 unique veterans and averages 1395 visits with these veterans. Most of these dietary encounters occur at the SVA infusion center while veterans are getting treatment or in the SVA oncology exam room after the veteran visits with their oncologic provider.

Methods: To provide this same dietary service to Kernersville and Charlotte veterans, the dietary oncology telehealth program was established. The program has performed 99 telehealth visits. The telehealth visits accomplish the same objectives as the live clinic appointments.

Common dietary issues that are managed in the clinic involve weight loss in lung cancer veterans, weight gain in prostate cancer veterans, and malabsorption in colorectal cancer veterans. The oncology dietician has competency and resources in managing these nutrition impact symptoms.

Implizations: Ideas for expansion of the Salisbury oncology dietary telehealth program would be to utilize the new Anywhere to Anywhere initiative, to improve access to veterans in the SVA system and to possibly aid other VAs oncology programs that do not have a dedicated oncology dietician.

Background: The Salisbury VA Medical Center (SVA) is a rural VA and some of our veterans with cancer are treated at VA Health Care Center (HCCs) in Kernersville or Charlotte. The VA telehealth platform provides a bridge to address dietary issues for veterans that cannot travel to Salisbury. The SVA offers virtual nutrition counseling sessions conveniently scheduled in conjunction with veterans HCC oncology visit and eliminates the need for additional appointments or having to arrange transportation to SVA.

Dietary counseling for veterans with cancer is an integral part of the SVA cancer care program. This commitment is shown by SVA Medical Centers commitment to a board certified oncology dietician FTE. The oncology dietician staffs the SVA outpatient medical oncology clinic and manages dietary issues that are present at diagnosis or arise during treatment. Annually, the oncology dietician averages a case load of 334 unique veterans and averages 1395 visits with these veterans. Most of these dietary encounters occur at the SVA infusion center while veterans are getting treatment or in the SVA oncology exam room after the veteran visits with their oncologic provider.

Methods: To provide this same dietary service to Kernersville and Charlotte veterans, the dietary oncology telehealth program was established. The program has performed 99 telehealth visits. The telehealth visits accomplish the same objectives as the live clinic appointments.

Common dietary issues that are managed in the clinic involve weight loss in lung cancer veterans, weight gain in prostate cancer veterans, and malabsorption in colorectal cancer veterans. The oncology dietician has competency and resources in managing these nutrition impact symptoms.

Implizations: Ideas for expansion of the Salisbury oncology dietary telehealth program would be to utilize the new Anywhere to Anywhere initiative, to improve access to veterans in the SVA system and to possibly aid other VAs oncology programs that do not have a dedicated oncology dietician.

Background: The use of oral chemotherapy, both as monotherapy and in combination with parenteral chemotherapy, has drastically increased. Goals of oral chemotherapy monitoring include initial patient education, assessment of adherence during therapy, ensuring baseline and routine lab monitoring, and testing. The provision of cost savings is performed when possible. To achieve these goals, a QI initiative was implemented to determine the feasibility of a multi-disciplinary oral chemotherapy monitoring program within a VA oncology clinic.

Methods: The QI initiative was started in February 2019. To facilitate and standardize communication between Oncology providers, Oncology Nursing staff and the Oncology Clinical Pharmacist (CPS), an “Oncology Chemotherapy Consult” was created. Entry of the consult in CPRS by the Oncology Provider alerts Oncology Nursing and Oncology Pharmacy staff to a new patient starting oral chemotherapy. The Oncology CPS receives and reviews the consult and verifies that a pharmacy Prior Authorization Drug Request Consult (PADR) has been entered, if applicable. All available labs are reviewed, and any additional baseline labs or testing are requested by the CPS. The Oncology RN designated for chemotherapy education provides face-to-face education for the medication(s) on the same day of the provider visit and determines the date of the return appointment for a toxicity screen approximately 14 days later. Once the PADR is reviewed and approved, the CPS completes the consult and orders a split-fill (15-day supply) of medication.

Results: The QI initiative to improve oral chemotherapy delivery and monitoring was proven effective and feasible. 95% of new oral chemotherapy patients have been enrolled in this program since its inception. Cost savings analysis is in progress and data will be available prior to the AVAHO meeting. Interventions performed to improve adherence and education will also be available

Conclusion: Based on results since initiation of this quality practice initiative, improved treatment adherence has been observed, early identification and management of toxicity has occurred, and utilization of a split-fill strategy for initial dosing has resulted in cost savings. Even in the early phase of this initiative, feasibility has been identified and increased benefit is predicted.

Background: The use of oral chemotherapy, both as monotherapy and in combination with parenteral chemotherapy, has drastically increased. Goals of oral chemotherapy monitoring include initial patient education, assessment of adherence during therapy, ensuring baseline and routine lab monitoring, and testing. The provision of cost savings is performed when possible. To achieve these goals, a QI initiative was implemented to determine the feasibility of a multi-disciplinary oral chemotherapy monitoring program within a VA oncology clinic.

Methods: The QI initiative was started in February 2019. To facilitate and standardize communication between Oncology providers, Oncology Nursing staff and the Oncology Clinical Pharmacist (CPS), an “Oncology Chemotherapy Consult” was created. Entry of the consult in CPRS by the Oncology Provider alerts Oncology Nursing and Oncology Pharmacy staff to a new patient starting oral chemotherapy. The Oncology CPS receives and reviews the consult and verifies that a pharmacy Prior Authorization Drug Request Consult (PADR) has been entered, if applicable. All available labs are reviewed, and any additional baseline labs or testing are requested by the CPS. The Oncology RN designated for chemotherapy education provides face-to-face education for the medication(s) on the same day of the provider visit and determines the date of the return appointment for a toxicity screen approximately 14 days later. Once the PADR is reviewed and approved, the CPS completes the consult and orders a split-fill (15-day supply) of medication.

Results: The QI initiative to improve oral chemotherapy delivery and monitoring was proven effective and feasible. 95% of new oral chemotherapy patients have been enrolled in this program since its inception. Cost savings analysis is in progress and data will be available prior to the AVAHO meeting. Interventions performed to improve adherence and education will also be available

Conclusion: Based on results since initiation of this quality practice initiative, improved treatment adherence has been observed, early identification and management of toxicity has occurred, and utilization of a split-fill strategy for initial dosing has resulted in cost savings. Even in the early phase of this initiative, feasibility has been identified and increased benefit is predicted.

Background: The use of oral chemotherapy, both as monotherapy and in combination with parenteral chemotherapy, has drastically increased. Goals of oral chemotherapy monitoring include initial patient education, assessment of adherence during therapy, ensuring baseline and routine lab monitoring, and testing. The provision of cost savings is performed when possible. To achieve these goals, a QI initiative was implemented to determine the feasibility of a multi-disciplinary oral chemotherapy monitoring program within a VA oncology clinic.

Methods: The QI initiative was started in February 2019. To facilitate and standardize communication between Oncology providers, Oncology Nursing staff and the Oncology Clinical Pharmacist (CPS), an “Oncology Chemotherapy Consult” was created. Entry of the consult in CPRS by the Oncology Provider alerts Oncology Nursing and Oncology Pharmacy staff to a new patient starting oral chemotherapy. The Oncology CPS receives and reviews the consult and verifies that a pharmacy Prior Authorization Drug Request Consult (PADR) has been entered, if applicable. All available labs are reviewed, and any additional baseline labs or testing are requested by the CPS. The Oncology RN designated for chemotherapy education provides face-to-face education for the medication(s) on the same day of the provider visit and determines the date of the return appointment for a toxicity screen approximately 14 days later. Once the PADR is reviewed and approved, the CPS completes the consult and orders a split-fill (15-day supply) of medication.

Results: The QI initiative to improve oral chemotherapy delivery and monitoring was proven effective and feasible. 95% of new oral chemotherapy patients have been enrolled in this program since its inception. Cost savings analysis is in progress and data will be available prior to the AVAHO meeting. Interventions performed to improve adherence and education will also be available

Conclusion: Based on results since initiation of this quality practice initiative, improved treatment adherence has been observed, early identification and management of toxicity has occurred, and utilization of a split-fill strategy for initial dosing has resulted in cost savings. Even in the early phase of this initiative, feasibility has been identified and increased benefit is predicted.

Background: Lung cancer is the leading cause of cancer-related deaths in the US In 2011, the National Lung Screening Trial (NLST) showed a 1.1% incidence of lung cancer in low-dose CT (LDCT) screened patients and a 20% relative risk reduction in mortality through LDCT screening. An estimated 900,000 out of 6.7 million veterans meet lung cancer screening criteria; therefore, an effective model to ensure proper screening is critical.

Methods: From December 2015 to May 2018, Salisbury VA Medical Center (SBYVAMC), Kernersville Health Care Center (KHCC), and Charlotte Health Care Center (CHCC) primary care providers screened and referred veterans to a centralized Lung Cancer Screening Program. Patients
were seen by providers in the Lung Cancer Screening Program and participated in shared decision making. Providers sought to ensure guidelines established by NLST and the Center for Medicare and Medicaid Services (CMS) for LDCT screening were met. Each patient’s age, sex, race, smoking history, LDCT date, results, and follow-up plan were recorded in a secured database. Data were queried for these patient characteristics and the appropriateness for LDCT screening was evaluated. Cases of cancer found on LDCT were clinically verified through a VA EMR review.

Results: Of 1124 screened, 1,104 (98.2%) veterans received an appropriate LDCT, according to strict CMS criteria. By NLST inclusion criteria, 1,088 of 1124 (96.8%) met strict criteria. Tumors were detected in 14 SBYVAMC patients (2.92%), 13 KHCC patients (3.05%), and 7 CHCC patients (3.21%). In total, 34 veterans (3.02%) had a tumor detected by LDCT. Of the 34, 27 veterans had primary lung cancer (79.4%) and 22 of these veterans had stage 1 lung cancer (64.7%).

Conclusions/Implications: This model of lung cancer screening demonstrates a high rate of appropriate LDCT screenings. Appropriate screening is critical to reducing unnecessary costs and potential harms to veterans. Additionally, a nearly three-fold higher incidence of cancer was found in this veteran population compared to the NLST trial.

Background: Lung cancer is the leading cause of cancer-related deaths in the US In 2011, the National Lung Screening Trial (NLST) showed a 1.1% incidence of lung cancer in low-dose CT (LDCT) screened patients and a 20% relative risk reduction in mortality through LDCT screening. An estimated 900,000 out of 6.7 million veterans meet lung cancer screening criteria; therefore, an effective model to ensure proper screening is critical.

Methods: From December 2015 to May 2018, Salisbury VA Medical Center (SBYVAMC), Kernersville Health Care Center (KHCC), and Charlotte Health Care Center (CHCC) primary care providers screened and referred veterans to a centralized Lung Cancer Screening Program. Patients
were seen by providers in the Lung Cancer Screening Program and participated in shared decision making. Providers sought to ensure guidelines established by NLST and the Center for Medicare and Medicaid Services (CMS) for LDCT screening were met. Each patient’s age, sex, race, smoking history, LDCT date, results, and follow-up plan were recorded in a secured database. Data were queried for these patient characteristics and the appropriateness for LDCT screening was evaluated. Cases of cancer found on LDCT were clinically verified through a VA EMR review.

Results: Of 1124 screened, 1,104 (98.2%) veterans received an appropriate LDCT, according to strict CMS criteria. By NLST inclusion criteria, 1,088 of 1124 (96.8%) met strict criteria. Tumors were detected in 14 SBYVAMC patients (2.92%), 13 KHCC patients (3.05%), and 7 CHCC patients (3.21%). In total, 34 veterans (3.02%) had a tumor detected by LDCT. Of the 34, 27 veterans had primary lung cancer (79.4%) and 22 of these veterans had stage 1 lung cancer (64.7%).

Conclusions/Implications: This model of lung cancer screening demonstrates a high rate of appropriate LDCT screenings. Appropriate screening is critical to reducing unnecessary costs and potential harms to veterans. Additionally, a nearly three-fold higher incidence of cancer was found in this veteran population compared to the NLST trial.

Background: Lung cancer is the leading cause of cancer-related deaths in the US In 2011, the National Lung Screening Trial (NLST) showed a 1.1% incidence of lung cancer in low-dose CT (LDCT) screened patients and a 20% relative risk reduction in mortality through LDCT screening. An estimated 900,000 out of 6.7 million veterans meet lung cancer screening criteria; therefore, an effective model to ensure proper screening is critical.

Methods: From December 2015 to May 2018, Salisbury VA Medical Center (SBYVAMC), Kernersville Health Care Center (KHCC), and Charlotte Health Care Center (CHCC) primary care providers screened and referred veterans to a centralized Lung Cancer Screening Program. Patients
were seen by providers in the Lung Cancer Screening Program and participated in shared decision making. Providers sought to ensure guidelines established by NLST and the Center for Medicare and Medicaid Services (CMS) for LDCT screening were met. Each patient’s age, sex, race, smoking history, LDCT date, results, and follow-up plan were recorded in a secured database. Data were queried for these patient characteristics and the appropriateness for LDCT screening was evaluated. Cases of cancer found on LDCT were clinically verified through a VA EMR review.

Results: Of 1124 screened, 1,104 (98.2%) veterans received an appropriate LDCT, according to strict CMS criteria. By NLST inclusion criteria, 1,088 of 1124 (96.8%) met strict criteria. Tumors were detected in 14 SBYVAMC patients (2.92%), 13 KHCC patients (3.05%), and 7 CHCC patients (3.21%). In total, 34 veterans (3.02%) had a tumor detected by LDCT. Of the 34, 27 veterans had primary lung cancer (79.4%) and 22 of these veterans had stage 1 lung cancer (64.7%).

Conclusions/Implications: This model of lung cancer screening demonstrates a high rate of appropriate LDCT screenings. Appropriate screening is critical to reducing unnecessary costs and potential harms to veterans. Additionally, a nearly three-fold higher incidence of cancer was found in this veteran population compared to the NLST trial.

Purpose: There are 2 major challenges as it relates to cancer care in rural Veterans. First is access to care for the increasing number of cancer survivors. Second is providing timely and effective care in those with a new diagnosis of cancer. Barriers to coordinated services for this rural population remain challenging. The complexity of the disease, its treatment, and follow up in the setting of a shrinking oncology workforce constitute an impending crisis in cancer delivery nationally. To address the increasing challenges oncologists face in delivering high-quality rural cancer care, the Salisbury VAMC Cancer Center created the Rural Oncology Specialty Care (ROSC) model in hopes of transforming rural oncology services. The goals of our program were to enhance the quality of survivorship, positively influence cycle time, and improve the quality of treatment.

Methods: To accomplish these goals, several leadership positions and programs were established. Rural oncology nurse navigators were trained to provide intensive coordination of care for rural Veterans. They assisted patients in navigating the barriers traditionally associated with rural cancer care, such as understanding of their diagnosis, access to resources, communication of complex treatment plans, cultural concerns, and emotional struggles. The navigators also helped patients and their families with scheduling appointments and coordinating care between services. The Rural Tele-Oncology Program was also established as a key component of the ROSC model. The goal of this program was to bring expertise to rural communities by becoming intricately involved in both the acute phase of diagnosis and chronic phase of survivorship. Finally, Survivorship Pathways were designed with the goal of ensuring early survivorship goals were met in a timely manner. The VA oncologist set out to work closely with the patient’s primary care physician with the goal of the primary care team becoming an integral part of the Veteran’s support system after remission.

Conclusions: The ROSC model was notably successful in decreasing cycle times and improving the quality of both cancer treatment and survivorship care. This program may indeed have national impact given the increasing number of rural oncology Veterans who need support services to ensure timely, effective care.

Purpose: There are 2 major challenges as it relates to cancer care in rural Veterans. First is access to care for the increasing number of cancer survivors. Second is providing timely and effective care in those with a new diagnosis of cancer. Barriers to coordinated services for this rural population remain challenging. The complexity of the disease, its treatment, and follow up in the setting of a shrinking oncology workforce constitute an impending crisis in cancer delivery nationally. To address the increasing challenges oncologists face in delivering high-quality rural cancer care, the Salisbury VAMC Cancer Center created the Rural Oncology Specialty Care (ROSC) model in hopes of transforming rural oncology services. The goals of our program were to enhance the quality of survivorship, positively influence cycle time, and improve the quality of treatment.

Methods: To accomplish these goals, several leadership positions and programs were established. Rural oncology nurse navigators were trained to provide intensive coordination of care for rural Veterans. They assisted patients in navigating the barriers traditionally associated with rural cancer care, such as understanding of their diagnosis, access to resources, communication of complex treatment plans, cultural concerns, and emotional struggles. The navigators also helped patients and their families with scheduling appointments and coordinating care between services. The Rural Tele-Oncology Program was also established as a key component of the ROSC model. The goal of this program was to bring expertise to rural communities by becoming intricately involved in both the acute phase of diagnosis and chronic phase of survivorship. Finally, Survivorship Pathways were designed with the goal of ensuring early survivorship goals were met in a timely manner. The VA oncologist set out to work closely with the patient’s primary care physician with the goal of the primary care team becoming an integral part of the Veteran’s support system after remission.

Conclusions: The ROSC model was notably successful in decreasing cycle times and improving the quality of both cancer treatment and survivorship care. This program may indeed have national impact given the increasing number of rural oncology Veterans who need support services to ensure timely, effective care.

Purpose: There are 2 major challenges as it relates to cancer care in rural Veterans. First is access to care for the increasing number of cancer survivors. Second is providing timely and effective care in those with a new diagnosis of cancer. Barriers to coordinated services for this rural population remain challenging. The complexity of the disease, its treatment, and follow up in the setting of a shrinking oncology workforce constitute an impending crisis in cancer delivery nationally. To address the increasing challenges oncologists face in delivering high-quality rural cancer care, the Salisbury VAMC Cancer Center created the Rural Oncology Specialty Care (ROSC) model in hopes of transforming rural oncology services. The goals of our program were to enhance the quality of survivorship, positively influence cycle time, and improve the quality of treatment.

Methods: To accomplish these goals, several leadership positions and programs were established. Rural oncology nurse navigators were trained to provide intensive coordination of care for rural Veterans. They assisted patients in navigating the barriers traditionally associated with rural cancer care, such as understanding of their diagnosis, access to resources, communication of complex treatment plans, cultural concerns, and emotional struggles. The navigators also helped patients and their families with scheduling appointments and coordinating care between services. The Rural Tele-Oncology Program was also established as a key component of the ROSC model. The goal of this program was to bring expertise to rural communities by becoming intricately involved in both the acute phase of diagnosis and chronic phase of survivorship. Finally, Survivorship Pathways were designed with the goal of ensuring early survivorship goals were met in a timely manner. The VA oncologist set out to work closely with the patient’s primary care physician with the goal of the primary care team becoming an integral part of the Veteran’s support system after remission.

Conclusions: The ROSC model was notably successful in decreasing cycle times and improving the quality of both cancer treatment and survivorship care. This program may indeed have national impact given the increasing number of rural oncology Veterans who need support services to ensure timely, effective care.