Cancer answers: Patient Care Connect Program sheds light on a dark time

Published On: 09.21.16 |

By: Matt Windsor

Cancer answers: Patient Care Connect Program sheds light on a dark time

Gabrielle-Rocque-MD-Assistant-Professor-in-the-UAB-School-of-Medicines-Division-of-Hematology-and-Oncology-and-Medical-Director-of-the-Patient-Care-Connect-Program. (Photo courtesy of UAB)

Everyone knows someone who has battled cancer. The assault on the disease at UAB is happening on many fronts, from petri dishes to population studies that span the globe. We will feature a special wellness series this week by Matt Windsor, taking a look at how this institution is fighting back against the ravaging effects of cancer at home and abroad.

Coping with the physical and mental challenges of cancer is difficult enough. But at times, the questions can be even harder. What will the treatment be like? What will it cost? Where can I stay? What do I do next? A program developed at UAB uses lay guides to give patients the answers they need. Research shows that it could save millions of dollars in health care costs, too.

Gabrielle Rocque, MD, Assistant Professor in the UAB School of Medicine’s Division of Hematology and Oncology and Medical Director of the Patient Care Connect Program. (Photo courtesy of UAB)

“When you hear the word ‘cancer,’ you feel that life is just over,” said Jim Whitener, who was diagnosed with mantle cell non-Hodgkin lymphoma at the UAB Comprehensive Cancer Center in 2013. But as soon as Whitener’s physician left the room, John French walked in. French isn’t a doctor or a nurse, or even a former cancer patient. He is a lay navigator in the UAB Patient Care Connect Program.

But he is well aware of the shock that comes with a cancer diagnosis. When he was a young man, his mother was diagnosed with cancer. She later survived a heart attack and three strokes, including one so severe that he had to put college on hold to care for her.

From wigs to what-ifs

French, and the other navigators in the program, are specially trained both to give patients an overview of the cancer journey, and get down into the crucial specifics. They know where a patient can find a wig after chemotherapy robs her of her hair; how to apply to drug companies’ compassionate care programs to reduce the cost of treatment; and when a patient should call a nurse or doctor to deal with unexpected symptoms. The goal is to help each patient be able to say, “these are the steps I need to take to improve my quality of life,” French said.

Patient Care Connect was launched in 2013 with a $15-million Health Care Innovation Challenge Grant Award from the Centers for Medicare and Medicaid Innovation. It pairs cancer patients with lay navigators at 12 hospitals in a five-state region of the Deep South.

The navigators are “a voice for the patient,” said Comprehensive Cancer Center Director Edward Partridge, M.D., who is principal investigator for the project. The goal, he says, is better health for individual patients, a better health care system and lower costs.

Thousands of patients across the South benefitted from the Patient Care Connect Program over the past four years, says Gabrielle Rocque, M.D., assistant professor in the UAB School of Medicine‘s Division of Hematology and Oncology and medical director of the Patient Care Connect Program. In a study presented at the American Society of Clinical Oncology annual meeting last summer, UAB researchers reported that hospitalization rates dropped significantly among navigated patients, from 35.8 percent to 16.1 percent. There were also significant declines in ER visits (from 30.7 percent to 21.8 percent) and ICU admissions (10 percent to 4 percent). That is good news for patients; it also represents a savings in health care costs that benefits all taxpayers. Medicare claims fell from $15,091 to $8,269 per patient per quarter, a savings of $6,822 per navigated patient.

The hospitals taking part in Patient Care Connect are members of the UAB Health System Community Network, Rocque explains. The network was designed to share the benefits of UAB innovations and expertise with community hospitals across the South. The navigators used “distress thermometers” to carefully record the problems that were most troubling to their patients.

This data, from tens of thousands of patients, is helping researchers spot gaps in care and helping hospitals find new ways to help patients. For example, “in Dothan, they identified that one of their big gaps was transportation,” Rocque said. “So the hospital created a transportation fund to help patients. That was exciting.”

Eyes on the community

Rocque, who specializes in breast cancer, is familiar with both the innovative power of academic medical centers and the unique challenges and opportunities for physicians in small practices. Her father is an oncologist who was on faculty at Dartmouth College’s School of Medicine before moving to Wisconsin to run a community practice. She is currently studying for a master’s degree from the School of Public Health in Health Care Organization and Policy, to hone her skills in outcomes research. She predicts that the study will provide a wealth of insight over the coming years.

Patient Care Connect offers “a wonderful environment for research and community outreach,” Rocque said. The UAB team has collected a vast amount of information, including claims data for 30,000 patients and carefully documented distress-thermometer results from navigated patients. This has allowed the researchers to produce utilization metrics, cost analyses and other detailed reports. An evaluation team led by Maria Pisu, Ph.D., an associate professor in the Division of Preventive Medicine, has helped turn this mountain of data into actionable information. Rocque regularly visits participating community hospitals to share this data with hospital leadership and individual physicians.

Applications beyond cancer

In some cases, the UAB team noted variations in treatment usage and practices among providers in the network. “It is not appropriate to prescribe a CT scan for every patient with early-stage breast cancer, but some physicians do that as a routine part of their practice,” Rocque said. “As physicians, we don’t practice in the same room. Because we don’t often get to see how our colleagues handle similar cases, these data-sharing sessions can allow some physicians to see, ‘I’m an outlier in the way I handle this.’” The Patient Care Connect team also helped the hospitals implement Choosing Wisely, a national campaign from the American Board of Internal Medicine that is designed to identify procedures that have high cost and low value. They were also able to spread the word about effective innovations at different locations, such as the telephone triage protocol adopted by one hospital system, which improved patient adherence to scheduled appointments.

The UAB Health System is now “alpha testing” Patient Care Connect with interested health systems around the United States. “If we can do this across these different practice environments, which are essentially a microcosm of the entire health care system, we can feel confident that this should work in virtually any location,” Rocque said. “There’s also no reason to think that this won’t work for other disease issues, especially chronic diseases.”

Monday: UAB fight against cancer happening across many fronts.

Tuesday: Big Epidemiology: Detective work with millions of lives at stake.

Thursday: How a superstar surgeon can make a difference.

Friday: The economic impact of cancer research.