# Presentation: 086841

## Slide 1

## Influencing Factors:

- Dr. John Niederhuber’s Vision
- Positively impact the care for cancer patients
- Success with Private Practice Model and Hospital/Physician Relationship
- Opportunity to share best practices and learn from other sites

**Notes:**
Key to our decision to apply for this prestigious opportunity was our belief and recognition of Dr. John Niederhuber’s vision for cancer care across this nation.  We know from our experience that the majority of cancer care is delivered in centers quite similar to ours.  We are interested in a program that will discover the best approach to channeling advances discovered at the National Cancer Institute level to community cancer centers such as ours.  

Historically, we have had success within the private practice setting with respect to physician and hospital relationships across multiple disciplines from cardiac, orthopedics, women’s service to cancer care. This success played a major role in our decision to apply for this award.  The strength of our physician relationships contributed to our belief that we could present a team that would be responsive to the research questions asked through the NCCCP pilot.

We also saw this as an opportunity to benefit through the sharing of best practices among pilot sites, thus enabling us to stay on the forefront of cancer management in the community setting.

## Influencing Factors

- Region marked by Disparities-racial, urban, rural, economic.
- Disparity in mortality rates for African Americans compared to Caucasians:  221.9 per 100,000 and 197.2 per 100,000 respectively
- 13% increased risk for African Americans in Chatham County

**Notes:**
Our region represents a wide range of cultural and economic factors that we believe the NCCCP project will help us to address.   For example, according to reports through the Chatham County Health Department, the cancer mortality rates per 100,000 African Americans are higher than those of our Caucasian population.  

## Influencing Factors:

- Savannah – African Americans 58% of the population yet make up 76% of those in poverty
- Primary Market Region
** ****17% below poverty level income**
- 100 Black Men of Savannah
- Long history of community outreach—
**SJ/C Mission Services**
**St. Mary’s Health Center**

**Reach **
**& **
**Teach**

**Notes:**
Additionally, Savannah’s Anti-Poverty Task Force noted that 58% of the Savannah area population is African American and this same population accounts for 76% of the poverty in Savannah.  Across our entire service region, 17% are below poverty level income.

SJ/C is a faith based system that has recognized these stark attributes of our region and have initiated several programs that serve to change these statistics.  We believe good health depends on many factors including safe and affordable housing, good nutrition, health information, worthy employment and healthcare access.  We believe that whenever possible services should be provided in the community.  The St. Mary’s Health Center and Community Centers are examples of the realization of our mission and philosophy.

Our long history of outreach is marked by such programs as the Barbershop initiative through SJ/C and the Community Cardiovascular Council where we train local barbers to give our health information and take blood pressures.  Also, our program with the African American Men’s Health Initiative  focuses on the health conditions that adversely affect African American males.

## Challenges & Opportunities

- Challenge:
**Bridging cultural gaps**
**Advocating for healthy lifestyles- reducing behaviors associated with heightened cancer risks**
**Health Literacy – increasing understanding**
**Assuring the same standard of care**
**Electronic Medical Record**

**Notes:**
Going forward on this pilot project,  we believe the challenges and opportunities we face relate to the very factors that influenced our decision  to participate.  

We recognize that cultural and socio-economical differences will have to be addressed in a manner that is unique to each community.  For example, health literacy  -- think of people who land in a foreign country and do not know the language– what are their abilities  to maneuver without truly knowing the language?  That is what it is like for our patients.  We are exploring through our local and regional coalitions how to influence health literacy.  This is both a challenge and an opportunity for us.

Another challenge is assuring the same standard of care, regardless of a patient’s financial/economic status, across health systems where the care is primarily delivered through private practices.  We believe by engaging our practitioners in the adoption and development of guidelines that drive care we will be able to influence this consistency of delivering the same high standard for all patients.

## Challenges & Opportunities

- Opportunities
**Capitalize on existing outreach infrastructure to test new approaches **
**Engage Cancer Action Team physicians to address challenges, create pathways that assure the same standard of care for all patients**
**Address Health Literacy across disparities**

**Addressing these **
**Opportunities will**
**influence success of**
**the NCCCP across**
**the region**

**Notes:**
By capitalizing on our existing infrastructure for outreach and the responsiveness of our physicians through our cancer action teams,  the challenges we face will be offset.

Through our local and regional coalitions, we have the opportunity to further extend the efforts of the NCCCP pilot.

## Challenges & Opportunities

_**Regional Cancer Coalitions of Excellence**_
**Focus- Early detection**

- --SJ/C  & Southeast Georgia Cancer Alliance (25 counties)—Health Literacy

**Through collaborative**
**efforts– address **
**disparities**

**Opportunity:**

**Notes:**
We work closely with the South East Georgia Cancer Alliance which is  a Regional Cancer Coalition of Excellence that we helped to organize in conjunction with the area hospitals and universities.  This alliance resulted from initial funding from the tobacco settlement dollars awarded through the Georgia Cancer Coalition. 

## State  & National Relationships

**Georgia Cancer Coalition**

**Institute of Medicine**

**Notes:**
Our regional efforts with the coalitions of excellence grew into statewide involvement with the Georgia Cancer Coalition shortly after the Institute of Medicine’s report on assessing the quality of cancer care across Georgia.  

In 2003, GCC commissioned the IOM to develop indicators that would help the state to determine if we are making progress against cancer as a result of targeting the tobacco settlement dollars toward this effort.

Following the release of the IOM report in 2005,  SJ/C voluntarily stepped up to test whether the indicators recommended by the IOM could be collected within a community hospital setting without creating an undue burden on the operations.  Working closely with our breast cancer action team, we were able to collect 20 of 21 indicators associated with breast cancer.

We took this experience and summarized it in a toolkit publication for other hospitals that want to voluntarily collect this information.  Going forward, we have been working closely with the Georgia Cancer Coalition to continue this effort.

## Challenges & Opportunities

**Challenges & Opportunities**

**Beyond the Region:**
**SJ/C & the Georgia Cancer Coalition:**
***Georgia Cancer Quality Information Exchange ***
*** ******“******The Exchange”***
***Clinical Alliances***

- Columbus

- Savannah

- Rome

**Notes:**
The Georgia Cancer Coalition has developed “The Exchange”  which is similar to a state wide Regional Health Information Organization –RHIO—

Through this data repository, Georgia will be able to track the progress of cancer care by utilizing data from multiple sources that will role up into one patient record.

SJ/C participated with the GCC to introduce to Harbin Clinic in Rome, Georgia the toolkit that resulted from our efforts.  GCC has since instituted additional demonstration projects and sites for the lung and breast cancer indicators. 

From these efforts, we have formed a clinical alliance to address quality in cancer care in three regions of the state that have strong Regional Coalitions of Excellence and are tied in with statewide initiatives through the GCC.

## Opportunity:  Explore Links with the Cancer Biomedical Informatics Grid

**Notes:**
We believe this groundwork that is already in place with the Georgia Cancer Coalition through our demonstration projects and efforts provides an excellent opportunity to explore linkages with the NCI’s Cancer Biomedical Informatics Grid.

## GCC:  SJ/C & HC: Researching &  Reporting on 42 of 52  IOM  indicators 

**Adult**
**Smoking**

**Advice to**
**Quit Smoking**

**Pharmacotherapy to**
**Quit Smoking**

**Adult**
**Obesity**

**Adolescent **
**Smoking**

**Cancer Incidence**
**All Sites**

**Breast Cancer**
**Incidence**

**Lung Cancer**
**Incidence**

**Colorectal Cancer**
**Incidence**

**Prostate Cancer**
**Incidence**

**Breast Cancer**
**Screening**

**Colorectal Cancer**
**Screening**

**Advanced-stage**
**Colorectal Cancer**

**Early-stage**
**Breast Cancer**

**Advanced-stage**
**Breast Cancer**

**EBRT/Hormone**
**Prostate Cancer**

**Inappropriate**
**Hormonal Therapy**

**Participation in**
**Clinical Trials**

**Adjuvent Radiation Ther**
**Breast Cons Surg**

**Adjuvent Hormonal Ther**
**Inv Breast Cancer**

**Appropriate EBRT**
**Prostate Cancer**

**Prevalence of Pain**
**Cancer Patients**

**Mammography**
**After Treatment**

**Cancer Pain**
**Assessment**

**Adjuvent Chemo Ther**
**Breast Cancer**

**Adjuvent Chemo**
**Colorectal Cancer**

**Colonoscopy**
**After Treatment**

- Prevention

- Screening &
- Early Detection

- Diagnosis &
- Staging

- Treatment & Palliation

**Hospice**
**Length of Stay**

**Cancer Deaths**
**In Hospice**

**Breast Cancer**
**5/10 Survival Rate**

**Breast Cancer**
**Mortality Rate**

**Colorectal Cancer**
**5/10 Survival Rate**

**Lung Cancer**
**5/10 Survival Rate**

**Prostate Cancer**
**5/10 Survival Rate**

**All Cancers**
**Mortality Rate**

**Colorectal Cancer**
**Mortality Rate**

**Lung Cancer**
**Mortality Rate**

**Prostate Cancer**
**Mortality Rate**

**Path Reports for**
**Lung Cancer**

**Lung Cancer**
**Stage Determined**

**Timely Breast**
**Cancer Biopsy**

**Clean Margins**
**Breast Surgery**

**Needle Biopsy**
**For Breast Cancer**

**Hist Assessment**
**Breast Cancer**

**Path Reports for**
**Breast Cancer**

**Path Compliance**
**for Specimens**

**Breast Cancer**
**Stage Determined**

**Hist Assessment**
**Colorectal Cancer**

**Path Reports for**
**Prostate Cancer**

**Colorectal Cancer**
**Stage Determined**

**Prostate Cancer**
**Stage Determined**

- Key:

- Currently available Public Health Data
- SJ/C and Rome Demonstration Project Data

- _GCC:  SJ/C & HC: Researching &  Reporting on 42 of 52  IOM  indicators_** **

**Path Reports for**
**Colorectal Cancer**

**Notes:**
Working closely with the clinical alliance, we are already building a data repository to track care across the recommended indicators.  We are working closely with our Harbin Clinic alliance partner to demonstrate aggregate data and reporting capabilities as a pilot for statewide reporting.  

Target for September 1st of this year is the reporting of 42 of the 52 IOM recommended indicators.    As you can see, these indicators cover the continuum of the disease from Prevention through treatment, palliation and survivorship.  Although this is for demonstration purposes and not readability, the green highlighted indicators are those that can only be pulled through the physician/hospital setting.  The blue are available through Public Health Data.

 We are fortunate to have physicians that are interested in research and address clinical trials in their treatment planning conferences and are involved in national accreditation efforts.  Doctors such as our own PI, Dr. Morris Geffen, who take the time to invest of their expertise in the advancement of technologies within a community cancer center setting.  Dr. Geffen, 

## Cancer  Research Networks

**Cancer  Research Networks**

**Cooperative **
**Groups**
** ****State wide **
**clinical trials**
**NCI Designated **
**Cancer Centers**

**Notes:**
Thank you, Paul.  

Our experience with clinical trials and research has grown almost immediately with the affiliation in 2003 with  the H. Lee Moffitt Cancer & Research Institute –a NCI designated cancer center, the only one in our region, located in Tampa.

We participate in the cooperative group trials through Moffitt as well as trials through the Georgia Cancer Coalition.

In addition, we have participated in a national research consortium through Siemens to test advances in technology in the clinical setting.  Often we are testing innovative techniques before they are approved by the FDA.  

## IGRT: 4D Planning

**Notes:**
Image guided radiation therapy and 4D treatment planning is an example of one of the latest in advancements that we served as a Clinical test site.

Our experience with national research consortiums, such as the Siemens Research Consortium have allowed us test new technologies in the treatment and delivery ahead of the market.  The MVision 4-D Adaptive Therapy is one of the advances.  As you can see in the next slide, this advancement in delivery allows us to ________________

## MVision-4 D Adaptive Therapy

**Siemens**
** ****Research**
**Consortium**

**Notes:**
These experiences contribute to the factors and connections on a national level that we believe will  serve as opportunities for this pilot project.  Of the sites selected, several use the same types of equipment and I am sure those who use other vendors are pursuing excellence in technology at the community level.  

This project brings these pursuits together to acknowledge best practices and challenges us to explore how to heighten awareness of these advances to community providers–  the field of cancer, as we all know, it is the combination of advances across disciplines in a multi-disciplinary format.  

Our experience, as a predominantly private practice health care system, is based on the ongoing maturity of  our physician/hospital relationships.  The physicians.... (next slide)

## Provider Experience:

_**Progressive Private Practice Medical Staff**_** --- ****Adopting guidelines and nationally recommended techniques**
**Participating in statewide clinical trials (Georgia CORE) and cooperative trials through H. Lee Moffitt.**
**Participating in Tissue Banking through Medical College of Georgia**
**Comparing current practices against NCCN guidelines through Cancer Action Teams**

**Notes:**
Represent a group of progressive individuals that come together routinely whether it is voluntarily giving of their time to multi-disciplinary weekly conferences and treatment planning or to the five different site specific cancer action teams that meet monthly.

These teams address clinical trials.

The implementation of our tissue banking program through the Medical College of Georgia – targeted to be in full swing this fall.

And then critically looking at our own practice patterns and comparing them with national guidelines to determine areas for improvements.    

These are just a few of the provider or physician experiences that we bring to this pilot effort. 

## Patients/Community Experience

- Patient Navigation Services
- Community Education

**Mobile Mammography Services**
**HealthQuest Services**
**8 - YMCA Health Education & Screening Programs**
**Physician educational lectures **

**Notes:**
Our patients benefit from the support services and outreach infrastructure that exists at the LCRP.

Patient navigators, nurses and social workers, are in place to assist the vulnerable populations/patients with guidance through sometimes a complicated healthcare experience that covers the continuum of care from prevention through treatment and follow up.

In addition, the nurse navigators team up with the physicians to provide community education and screening services.  Just a few of our programs are listed here. 

## Patients/Community Experience

- Transportation to Treatments
- St. Mary’s Health Center
- MedBank Foundation
- Mercy Housing
- St. Mary’s Community Center
- The Community Healthcare Center
- Georgia Infirmary

**Notes:**
Making sure our patients have access to treatment, as well as drug coverage is very important to us.

Not only do our social work patient resource navigators seek drug replacement and co-pay benefits for our patients, we support MedBank Foundation which assists the uninsured in obtaining prescription medications at reduced or no charge.

The LCRP provides the continuum of care for patients diagnosed through the Community Healthcare Center which provides primary care to the uninsured.

These are just highlights of our experience and our patient’s experience as we work through the processes that address access to care and focus on reducing the disparities that we know exist in healthcare today.

## Physician & Hospital Commitment

- Influence the delivery of cancer care across the nation through participation in the NCCCP pilot at *St. Joseph’s/Candler and the  Nancy N. and J. C. Lewis Cancer and Research Pavilion*

**Notes:**
Because of our past experiences and service to our patients through St. Joseph’s/Candler  and the Lewis Cancer & Research Pavilion,  we can confidently assert our commitment to the NCCCP pilot project.  Thank you.