MULTIDISCIPLINARY CLINICAL TEAMS + PATIENT NAVIGATION

+ GENETIC COUNSELING + CLINICAL RESEARCH + CLINICAL

EDUCATION + INTEGRATIVE MEDICINE + PATIENT SUPPORT

AND EDUCATION + INNOVATIVE CLINICAL TRIALS CENTER

+ SURVIVOR CELEBRATIONS + COMMUNITY OUTREACH

2014 ONCOLOGY ANNUAL REPORTBUILDING On STRENGTH

HIGHER THAN NORMAL INCIDENCE OF POST-

OPERATIVE ILEUS IN COLON SURGERY PATIENTS

TRIGGERS EVALUATION OF TPN ADMINISTRATION

In early 2014, the Oncology unit at Baylor Scott & White Medical Center - Plano* noted a higher than expected incidence of post-operative ileus in colon surgery patients. During its evaluation, TPN administration emerged as a potential cause. The unit immediately identified this as an opportunity to improve patient care and reduce costs associated with TPN administration and an improvement initiative was launched.

While TPN provides nutrition to patients unable to be fed enterally, the approach comes with inherent risks and cost. The identified risks included hyperglycemia, electrolyte and mineral abnormalities, liver dysfunction, line infection and sepsis. The costs to the hospital for TPN administration ranged from $74-$200 per day, not including labor and supply costs. Treating patients who developed sepsis involved an average cost of $22,000 per case.

A special team of oncology clinicians and registered dietitians was convened to analyze the current situation and identify potential interventions that would result in improved patient care and reduced costs.

Using the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines for TPN administration, the team evaluated 30 post-operative colon surgery patients that received TPN in 2014. The Best Care Committee at the hospital approved the A.S.P.E.N. guidelines in July 2014. Of the 30 cases, TPN was indicated for 18 (60%) patients who averaged 13.4 appropriate days per patient. TPN was not indicated for twelve (40%) of the patients who averaged 6.0 inappropriate days per patient.

To help educate team members, a TPN administration flow chart was created based on A.S.P.E.N. guidelines. The flow chart provided a quick visual guide for caregivers to help them determine when TPN was appropriate.

Once the analysis of the patient group was completed, the team embarked on educating referring physicians and caregivers. Physician education was initially achieved through an article in the hospital’s physician newsletter. The team then monitored physician practice after the article appeared and determined additional education was required. Members of the team met face-to-face with physicians who frequently ordered TPN for post-operative colon surgery patients to educate them on the hospital’s new approach.

The team monitored the number of post-operative colon surgery patients receiving TPN from July 1, 2014 to December 31, 2014. From an initial high of eight (8) patients per month, the number of patients receiving TPN fell to zero (0) in December.

The hospital also found that cost savings generated by the improvement initiative increased over time, rising from around $12,000 per case in July/August 2014 to more than $20,000 in November/December 2014.

The success of the TPN improvement resulted in the hospital’s permanent adoption of the A.S.P.E.N. guidelines. Please see guidelines on next page.

*All 2014 data and recognition applies to Baylor Regional Medical Center at Plano which changed its name to Baylor Scott & White Medical Center - Plano in Spring, 2016.

CANCER SCREENINGSBAYLOR SCOTT & WHITE - PLANO 2014

COMMUNITY NEEDS ASSESSMENT

CANCER SCREENINGS AND OUTCOMES

Baylor Scott & White - Plano performs a “Community Needs Assessment” every three years to identify health care disparities and barriers to care for patients within our service area. Once these barriers are identified, Baylor Scott & White - Plano is able to develop strategies to address these needs. The chart below shows the community cancer screenings offered and the outcomes

of the screenings at Baylor Scott & White - Plano during 2014. Patients who are screened and found to be at risk for cancer need follow-up treatment and evaluation by cancer specialists. These patients are referred to a nurse navigator who helps the patient connect with an appropriate specialist.

TUMOR SITE SCREENING TYPE TOTAL ABNORMAL

BreastScreening Mammography 10,792 11.29%Mobile Mammography Van 219 6.39%

Gastrointestinal Colonoscopy Screening 183 63.98%Lung/Thoracic Low Dose Lung CT Screening 22 31.82%Head & Neck Oral, Head, and Neck Screening 56 0.00%Melanoma Skin Cancer Screening 163 27.61%

A.S.P.E.N. GUIDELINES FOR TPN ADMINISTRATION

• EN is the preferred route of feeding over PN in the critically ill patient who requires nutrition support.

• PN therapy provided for a duration of <5-7 days would be expected to have no outcome effect and may result in increased risk to the patient. Thus PN should be initiated only if the duration of the therapy is expected to be >7 days.

• In the patient who was previously healthy prior to critical illness, with no evidence of protein calorie malnutrition, use of PN should be reserved and initiated only after the first 7 days of hospitalization (when EN is not available).

• In the ICU population, neither the presence nor absence of bowel sounds nor evidence of passing of flatus and stool is required for the initiation of enteral feeding.

CLINICAL PROGRAM PRACTICE PROFILE REPORT (CP3R)ONCOLOGY QUALITY METRICS

NCDB Target

CoC Stateof Texas

PerformanceRate

CoC Census Region (West)

PerformanceRate

All CoCPrograms

PerformanceRate

Baylor Scott & White - Plano

Performance Rate

Breast Cancer 2015 Forward Diagnosis Year 2011 (CoC) 2012* 2013*

BCS: Breast Conservation surgery rate for women with AJCC clinical stage 0, I, or II breast cancer (Surveillance Measure)

NA 54.3% 57.0% 63.9% 43.2% 57.7%

NbX: Image or palpation-guided needle biopsy (core or FNA) is performed for the treatment of breast cancer (Quality Improvement Measure)

80.0% 73.2% 74.0% 76.4% 90.0% 92.9%

HT: Adjuvant Hormonal Therapy: Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1cNoMo, or Stage II or III hormone receptor positive breast cancer (Accountability Measure)

90% 86.1% 87.1% 90.3% 95.9% 96.8%

MASTRT: Radiation therapy is considered or administered following any mastectomy within 1 year (365 days) of diagnosis for women with >= 4 positive lymph nodes (Accountability Measure)

90.0% 56.6% 61.4% 71.7% 100.0% 100.0%

BCRST: Post Breast Conserving Surgery Irradiation: Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 and receiving breast conserving surgery for breast cancer (Accountability Measure)

90% 86.8% 88.6% 91.8% 92.1% 100.0%

MACl: Adjuvant Chemotherapy: Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cNoMo, or Stage II or III hormone receptor negative breast cancer (Accountability Measure)

90% 90.0% 90.5% 92.5% 100.0% 100.0%

Colorectal CancerACT: Adjuvant Chemotherapy: Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis to patients under age 80 with AJCC III (lymph node positive) colon cancer (Accountability Measure)

NA 88.5% 89.4% 90.6% 85.7% 100.0%

12 RLN: Surgical Resection Includes at Least 12 Lymph Nodes: At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer (Surveillance Measure)

85% 90.5% 89.0% 87.8% 100.0% 96.9%

Rectal CancerRECRCT: Pre-operative chemo and radiation are administered for clinical AJCC T3N0, T4N0, or Stage III; or Postoperative chemo and radiation are administered within 180 days of diagnosis for clinical AJCC T1-2N0 with pathologic AJCC T3N0, T4N0, or Stage III; or treatment is considered, for patients under the age of 80 receiving resection for rectal cancer (Quality Improvement)

85% NA 100.0%

The Clinical Program Practice Profile Report (CP3R) was created by the American College of Surgeons’ Commission on Cancer (CoC). It provides a report-card style summary of program-specific performance rates for five process measures obtained from the National Cancer Data Base (NCDB): three for breast, one for colorectal and one for rectal cancer. The performance measures review how well a particular hospital delivers cancer care as determined by national treatment guidelines. These reports allow comparisons to other CoC-accredited programs by state, regional and national characteristics. The performance rates are based on retrospective data, typically 18-24 months after a patient’s diagnosis and treatment.

m Target m No CoC Benchmark

*Source: Data is pending results by the Rapid Quality Reporting Process via the National Cancer Data Base

Physicians provide clinical services as members of the medical staff at one of Baylor Scott & White Health’s subsidiary, community or affiliated medical centers and do not provide clinical services as employees or agents of those medical centers, Baylor Health Care System, Scott & White Healthcare or Baylor Scott & White Health. Photography may include models or actors and may not represent actual patients. ©2016 Baylor Scott & White Health. BID BHCSONC_83 4.16