From 1975 to 1977, the cancer survival rate in the United States was 49 percent whereas from 2001 to 2007, the cancer survival rate was 67 percent, which indicates an increasing demand for lifetime oncology services, Mr. Nussbaum said. There are a few key reasons the demand has grown over time: the aging population, the increased diagnostic capabilities and higher survival rates.
In order to continue to increase survival rates, it is important to understand the qualities of successful oncology programs. Mr. Nussbaum shared four common goals of oncology programs, which he believes provide context for the importance of oncology care.
• Provide patients access to cutting-edge treatment close to home.
• Integrate oncology care with overall healthcare services.
• Develop highly coordinated oncology networks that provide services at local sites, and coordinate high-acuity care across the network.
• Link clinicians across different geographies through information technology.
While the goals of oncology programs are relatively similar across various sites, there are differences in each site’s level of maturity to provide care to patients, Mr. Nussbaum said. Kurt Salmon conducted a study in which it ranked 132 inpatient oncology sites based on three areas: organization and governance; systems and resources; and clinical care coordination. According to the assessment, Kurt Salmon found oncology sites have one of three maturity levels.
1. Basic maturity. With basic maturity, there is a wide variation in practices across sites. There is also reliance on mostly manual and time-consuming processes to achieve coordination.
2. Intermediate maturity. Sites with intermediate maturity achieve a broad range of organizational objectives. They have decreased variation across care sites, more complex systems and processes coordinated through a central site.
3. Advanced maturity. Advanced maturity involves fully developed structures, policies and resources that drive achievement of robust goals. In addition, consistent and streamlined processes support improved care outcomes across all sites.
Overall, the three maturity levels show that longevity is correlated with more maturity. “The cancer networks and programs that were the most mature have been in existence the longest,” said Mr. Nussbaum.
Mr. Nussbaum closed with eight lessons that can be learned from successful and unsuccessful oncology sites.
1. Governance development determines network strength.
2. Clinical care coordination is not as prevalent as many perceive.
3. Clinical care coordination benefits from strong governance and dedicated resources.
4. Physician leadership is a critical element of success.
5. Paper still permeates clinical care documentation.
6. Information technology is viewed as a critical enabler of improved patient care.
7. Tumor boards remain mostly a locally focused forum.
8. A vision for use of tumor registry and electronic health record information to support research is coming into focus.
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