Psychosocial staffing at National Comprehensive Cancer Network member institutions: data from leading cancer centers

2015 ◽  
Vol 25 (2) ◽  
pp. 164-169 ◽  
Author(s):  
Teresa Deshields ◽  
Amanda Kracen ◽  
Shannon Nanna ◽  
Lisa Kimbro
Keyword(s):  
National Comprehensive Cancer Network ◽  
Network Member ◽  
Cancer Centers ◽  
Cancer Network

Psychology Staffing at Cancer Centers: Data From National Comprehensive Cancer Network Member Institutions

2020 ◽  
Vol 16 (11) ◽  
pp. e1343-e1354
Author(s):  
Laura Melton ◽  
Diana Krause ◽  
Jessica Sugalski
Keyword(s):  
National Comprehensive Cancer Network ◽  
Patient Care ◽  
Clinical Care ◽  
The United States ◽  
Direct Patient Care ◽  
Cancer Center ◽  
Network Member ◽  
Full Time ◽  
Cancer Centers ◽  
Cancer Network

PURPOSE: The field of psycho-oncology is relatively undeveloped, with little information existing regarding the use of psychologists at cancer centers. Comprising 30 leading cancer centers across the United States, the National Comprehensive Cancer Network (NCCN) set out to understand the trends in its Member Institutions. METHODS: The NCCN Best Practices Committee surveyed NCCN Member Institutions regarding their use of psychologists. The survey was administered electronically in the spring/summer of 2017. RESULTS: The survey was completed by 18 cancer centers. Across institutions, 94% have psychologists appointed to provide direct care to their cancer center patients. The number of licensed psychologist full-time equivalents (FTEs) on staff who provide direct patient care ranged from < 1.0 FTE (17%) to 17.0-17.9 FTEs (6%). Regarding psychologist appointments, 41% have both faculty and staff appointments, 41% have all faculty appointments, and 18% have all staff appointments. Forty-three percent of institutions indicated that some licensed psychologists at their centers (ranging from 1%-65%) do not provide any direct clinical care, and 57% indicated that all licensed psychologist on staff devote some amount of time to direct clinical care. The percent of clinical care time that is spent on direct clinical care ranged from 15%-90%. CONCLUSION: There is great variability in psychology staffing, academic appointments, and the amount of direct patient care provided by on-staff psychologists at cancer centers.

Compliance with National Comprehensive Cancer Network guidelines for antiemesis in cisplatin regimens.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 280-280
Author(s):  
Terri P. Wolf ◽  
Dana Ann Little
Keyword(s):  
National Comprehensive Cancer Network ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cancer Center ◽  
Adherence Rate ◽  
Cancer Centers ◽  
Nccn Guidelines ◽  
Guideline Compliance ◽  
Cancer Network ◽  
The Impact

280 Background: The members of a network of community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines. To determine guideline compliance, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting.The community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines for treatment plans. To determine guideline compliance rates, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting. Methods: Prior to a chart audit, medical oncologists were surveyed on their knowledge of NCCN antiemesis guidelines, frequency of prescribing based on guidelines, and reasons for not using guidelines. Auditors identified patient charts through billing records and reviewed cycle 1 day 1 orders of cisplatin regimens. Secondary data was collected on hydration orders and home medications for antiemesis. Results: Guideline adherence varied from 0% to 76% with overall adherence at 28%. Dexamethasone doses ranged from 2-20 mg (guideline 12 mg) as did serotonin antagonists (5HT3) ordered at higher IV doses of 24-32 mg (guideline 8-16 mg). Conclusions: Although cancer centers report following the guidelines, this study did not find consistent adherence. The cancer center with the highest adherence rate works closely with a pharmacist and has built order sets with the guidelines. One cancer center had wide variances among practitioners. The variances increase the potential for error. The cancer center with lowest adherence rate used 10 mg doses of dexamethasone because the drug is delivered in 10 mg vials. This study identified multiple systems issues impacting guideline compliance. Managing nausea and vomiting is important for patient QOL and to manage costs by decreasing hospitalizations, treatment delays, and nutritional deficits. Understanding prescribing habits relative to guidelines provides an opportunity to change practice and reduce variability.

scholarly journals A Study of Advanced Practice Provider Staffing Models and Professional Development Opportunities at National Comprehensive Cancer Network Member Institutions

2021 ◽  
Vol 12 (7) ◽  
Author(s):  
Annie Austin, MSN, AGACNP, AOCNP ◽  
Kellyann Jeffries, CNP ◽  
Diana Krause, MHA ◽  
Jessica Sugalski, MPPA ◽  
Karen Sharrah, DNP, APRN, FNPc ◽  
...  
Keyword(s):  
Professional Development ◽  
Leadership Development ◽  
National Comprehensive Cancer Network ◽  
Mixed Model ◽  
Network Member ◽  
Advanced Practice ◽  
Full Time ◽  
Full Time Equivalent ◽  
Cancer Network

Introduction: The National Comprehensive Cancer Network (NCCN) Best Practices Committee created an Advanced Practice Provider (APP) Workgroup to develop recommendations to support APP roles at NCCN Member Institutions. Methods: The Workgroup conducted three surveys to understand APP program structure, staffing models, and professional development opportunities at NCCN Member Institutions. Results: The total number of new and follow-up visits a 1.0 APP full-time equivalent conducts per week in shared and independent visits ranged from 11 to 97, with an average of 40 visits per week (n = 39). The type of visits APPs conduct include follow-up shared (47.2%), follow-up independent (46%), new shared (6.5%), and new independent visits (0.5%). Seventy-two percent of respondents utilize a mixed model visit type, with 15% utilizing only independent visits and 13% utilizing only shared visits (n = 39). Of the 95% of centers with APP leads, 100% indicated that leads carry administrative and clinical responsibilities (n = 20); however, results varied with respect to how this time is allocated. Professional development opportunities offered included posters, papers, and presentations (84%), leadership development (57%), research opportunities (52%), writing book chapters (19%), and other professional development activities (12%; n = 422). Twenty percent of APPs indicated that protected time to engage in development opportunities should be offered. Conclusion: As evidenced by the variability of the survey results, the field would benefit from developing standards for APPs. There is a lack of information regarding leadership structures to help support APPs, and additional research is needed. Additionally, centers should continuously assess the career-long opportunities needed to maximize the value of oncology APPs.

Preferences in Oncology History Documentation Styles Among Clinical Practitioners

2021 ◽  
pp. OP.20.00756
Author(s):  
Daniel B. Martin ◽  
Peter D. Stetson ◽  
G. Weldon Gilcrease ◽  
Robert C. Stillman ◽  
Jessica M. Sugalski ◽  
...  
Keyword(s):  
National Comprehensive Cancer Network ◽  
Social Determinants ◽  
Care Coordination ◽  
Real World ◽  
Semantic Differential ◽  
Network Member ◽  
Convenience Sample ◽  
Clinical Notes ◽  
Narrative History ◽  
Cancer Network

PURPOSE: Clinical notes function as the de facto handoff between providers and assume great importance during unplanned medical encounters. An organized and thorough oncology history is essential in care coordination. We sought to understand reader preferences for oncology history organization by comparing between chronologic and narrative formats. METHODS: A convenience sample of 562 clinicians from 19 National Comprehensive Cancer Network Member Institutions responded to a survey comparing two formats of oncology histories, narrative and chronologic, for the same patient. Both histories were consensus-derived real-world examples. Each history was evaluated using semantic differential attributes ( thorough, useful, organized, comprehensible, and succinct). Respondents choose a preference between the two styles for history gathering and as the basis of a new note. Open-ended responses were also solicited. RESULTS: Respondents preferred the chronologic over the narrative history to prepare for a visit with an unknown patient (66% preference) and as a basis for their own note preparation (77% preference) ( P < .01). The chronologic summary was preferred in four of the five measured attributes ( useful, organized, comprehensible, and succinct); the narrative summary was favored for thoroughness ( P < .01). Open-ended responses reflected the attribute scoring and noted the utility of content describing social determinants of health in the narrative history. CONCLUSION: Respondents of this convenience sample preferred a chronologic oncology history to a concise narrative history. Further studies are needed to determine the optimal structure and content of chronologic documentation for oncology patients and the provider effort to use this format.

scholarly journals Postoperative Adjuvant Chemotherapy Use in Patients With Stage II/III Rectal Cancer Treated With Neoadjuvant Therapy: A National Comprehensive Cancer Network Analysis

2013 ◽  
Vol 31 (1) ◽  
pp. 30-38 ◽  
Author(s):  
Polina Khrizman ◽  
Joyce C. Niland ◽  
Anna ter Veer ◽  
Dana Milne ◽  
Kelli Bullard Dunn ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
National Comprehensive Cancer Network ◽  
Systemic Chemotherapy ◽  
Neoadjuvant Chemoradiotherapy ◽  
Curative Intent ◽  
Cancer Centers ◽  
Cancer Network ◽  
Frequent Reason

Purpose Practice guidelines recommend that patients who receive neoadjuvant chemotherapy and radiation for locally advanced rectal cancer complete postoperative adjuvant systemic chemotherapy, irrespective of tumor downstaging. Patients and Methods The National Comprehensive Cancer Network (NCCN) Colorectal Cancer Database tracks longitudinal care for patients treated at eight specialty cancer centers across the United States and was used to evaluate how frequently patients with rectal cancer who were treated with neoadjuvant chemotherapy also received postoperative systemic chemotherapy. Patient and tumor characteristics were examined in a multivariable logistic regression model. Results Between September 2005 and December 2010, 2,073 patients with stage II/III rectal cancer were enrolled in the database. Of these, 1,193 patients receiving neoadjuvant chemoradiotherapy were in the analysis, including 203 patients not receiving any adjuvant chemotherapy. For those seen by a medical oncologist, the most frequent reason chemotherapy was not recommended was comorbid illness (25 of 50, 50%); the most frequent reason chemotherapy was not received even though it was recommended or discussed was patient refusal (54 of 74, 73%). After controlling for NCCN Cancer Center and clinical TNM stage in a multivariable logistic model, factors significantly associated with not receiving adjuvant chemotherapy were age, Eastern Cooperative Oncology Group performance status ≥ 1, on Medicaid or indigent compared with private insurance, complete pathologic response, presence of re-operation/wound infection, and no closure of ileostomy/colostomy. Conclusion Even at specialty cancer centers, a sizeable minority of patients with rectal cancer treated with curative-intent neoadjuvant chemoradiotherapy do not complete postoperative chemotherapy. Strategies to facilitate the ability to complete this third and final component of curative intent treatment are necessary.

scholarly journals National Comprehensive Cancer Network Infusion Efficiency Workgroup Study: Optimizing Patient Flow in Infusion Centers

2019 ◽  
Vol 15 (5) ◽  
pp. e458-e466 ◽  
Author(s):  
Jessica M. Sugalski ◽  
Timothy Kubal ◽  
Daniel L. Mulkerin ◽  
Rebecca L. Caires ◽  
Penny J. Moore ◽  
...  
Keyword(s):  
National Comprehensive Cancer Network ◽  
Patient Flow ◽  
Wait Time ◽  
Cancer Centers ◽  
Administration Routes ◽  
Chemotherapy Drugs ◽  
Average Patient ◽  
Patient Wait Time ◽  
Standard Practices ◽  
Cancer Network

PURPOSE: The National Comprehensive Cancer Network (NCCN) formed an Infusion Efficiency Workgroup to determine best practices for operating efficient and effective infusion centers. METHODS: The Workgroup conducted three surveys that were distributed to NCCN member institutions regarding average patient wait time, chemotherapy premixing practices, infusion chair use, and premedication protocols. To assess chair use, the Workgroup identified and defined five components of chair time. RESULTS: The average patient wait time in infusion centers ranged from 25 to 102 minutes (n = 23; mean, 58 minutes). Five of 26 cancer centers (19%) routinely mix chemotherapy drugs before patient arrival for patients meeting specified criteria. Total planned chair time for subsequent doses of the same drug regimens for the same diseases varied greatly among centers, as follows: Administration of doxorubicin and cyclophosphamide ranged from 85 to 240 minutes (n = 22); of FOLFIRINOX (folinic acid, fluorouracil, irinotecan hydrochloride, and oxaliplation) ranged from 270 to 420 minutes (n = 22); of rituximab ranged from 120 to 350 minutes (n = 21); of paclitaxel plus carboplatin ranged from 255 to 380 minutes (n = 21); and of zoledronic acid ranged from 30 to 150 minutes (n = 22) for planned total chair time. Cancer centers were found to use different premedication regimens with varying administration routes that ranged in administration times from zero to 60 minutes. CONCLUSION: There is a high degree of variation among cancer centers in regard to planned chair time for the same chemotherapy regimens, providing opportunities for improved efficiency, increased revenue, and more standardization across centers. The NCCN Workgroup demonstrates potential revenue impact and provides recommendations for cancer centers to move toward more efficient and more standard practices.

scholarly journals Benchmarks in Clinical Productivity: A National Comprehensive Cancer Network Survey

2007 ◽  
Vol 3 (1) ◽  
pp. 2-8 ◽  
Author(s):  
F. Marc Stewart ◽  
Robert L. Wasserman ◽  
Clara D. Bloomfield ◽  
Stephen Petersdorf ◽  
Robert P. Witherspoon ◽  
...  
Keyword(s):  
National Comprehensive Cancer Network ◽  
Fiscal Year ◽  
Clinical Activity ◽  
Full Time ◽  
Full Time Equivalent ◽  
Physician Practices ◽  
Cancer Centers ◽  
Physician Compensation ◽  
Potential Factors ◽  
Cancer Network

Purpose Oncologists in academic cancer centers usually generate professional fees that are insufficient to cover salaries and other expenses, despite significant clinical activity; therefore, supplemental funding is frequently required in order to support competitive levels of physician compensation. Relative value units (RVUs) allow comparisons of productivity across institutions and practice locations and provide a reasonable point of reference on which funding decisions can be based. Methods We reviewed the clinical productivity and other characteristics of oncology physicians practicing in 13 major academic cancer institutions with membership or shared membership in the National Comprehensive Cancer Network (NCCN). The objectives of this study were to develop tools that would lead to better-informed decision making regarding practice management and physician deployment in comprehensive cancer centers and to determine benchmarks of productivity using RVUs accrued by physicians at each institution. Three hundred fifty-three individual physician practices across the 13 NCCN institutions in the survey provided data describing adult hematology/medical oncology and bone marrow/stem-cell transplantation programs. Data from the member institutions participating in the survey included all American Medical Association Current Procedural Terminology (CPT®) codes generated (billed) by each physician during each organization's fiscal year 2003 as a measure of actual clinical productivity. Physician characteristic data included specialty, clinical full-time equivalent (CFTE) status, faculty rank, faculty track, number of years of experience, and total salary by funding source. The average adult hematologist/medical oncologist in our sample would produce 3,745 RVUs if he/she worked full-time as a clinician (100% CFTE), compared with 4,506 RVUs for a 100% CFTE transplant oncologist. Results and Conclusion Our results suggest specific clinical productivity targets for academic oncologists and provide a methodology for analyzing potential factors associated with clinical productivity and developing clinical productivity targets specific for physicians with a mix of research, administrative, teaching, and clinical salary support.

scholarly journals Estimativa do custo do tratamento do câncer de pele tipo não-melanoma no Estado de São Paulo - Brasil

2011 ◽  
Vol 86 (4) ◽  
pp. 657-662 ◽  
Author(s):  
Reynaldo José Sant'Anna Pereira de Souza ◽  
Adriana P Mattedi ◽  
Marcelo P Corrêa ◽  
Marcelo L Rezende ◽  
Ana Cláudia Andrade Ferreira
Keyword(s):  
Clinical Practice ◽  
National Comprehensive Cancer Network ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Sao Paulo ◽  
São Paulo ◽  
Cancer Network ◽  
Impacto Económico

FUNDAMENTOS: O câncer de maior incidência no Brasil é o de pele não-melanoma, que afeta aproximadamente 0,06% da população. Não existem políticas públicas para sua prevenção e o impacto econômico do seu diagnóstico não tem sido avaliado. OBJETIVOS: Estimar os custos do diagnóstico e tratamento do câncer de pele não-melanoma no Estado de São Paulo entre 2000 a 2007 e compará-los com os do melanoma cutâneo no mesmo período. MÉTODOS: Foi utilizado como modelo de procedimento o projeto diretriz Clinical Practice Guidelines in Oncology, (National Comprehensive Cancer Network), adequado aos procedimentos da Fundação SOBECCan - Hospital do Câncer de Ribeirão Preto - SP. Os custos estimados baseiam-se nos valores do tratamento médico pagos pelos setores público e privado em 2007. RESULTADOS: Os valores médios de custo individual do tratamento anual do câncer de pele não-melanoma são muito mais baixos do que os estimados para o tratamento do melanoma cutâneo. Entretanto, observados os gastos totais no tratamento do câncer de pele não-melanoma, percebe-se que os 42.184 casos deste câncer em São Paulo, no período estudado, fazem com que o custo total do seu tratamento seja 14% superior ao dos 2.740 casos de melanoma cutâneo registrados no mesmo período para o SUS. Porém, para o sistema privado, o gasto total é, aproximadamente, 34% menor para o tratamento do câncer de pele não-melanoma. CONCLUSÃO: O elevado número de casos de câncer de pele não-melanoma no Brasil - com 114 mil novos casos previstos para 2010, sendo 95% diagnosticados em estágios precoces - representa um impacto financeiro ao sistema público e aos sistemas privados de saúde de cerca de R$ 37 milhões e R$ 26 milhões ao ano, respectivamente

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