Mercy Pathway Through Breast Care

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1 1. Goal and program description Mercy Pathway Through Breast Care Goal: To institute a navigation project to provide mammography and breast cancer navigation services to all Medicaid patients to pilot over 2 years. To increase the number of Medicaid patients screened. To assist in the development of a web-based database that will be utilized in all three pilots. To increase screening mammography access to the Medicaid patients by providing additional access at a new location at 37 th and Cottage Grove. To improve access to the communities served with outreach, education and health line utilization. YEAR 1 The navigation pilot program at Mercy Hospital for Medicaid patients receiving mammography services will mirror the case management and outreach education process for BCCP with enhancements to address barriers to access. The pilot program for breast cancer patients will be an enhancement and the navigation will begin at the point of diagnosis into survivorship. The breast cancer navigation pilot will be a comprehensive team approach of the navigator, nurse case manager, and social worker. Clinical services for all patients will be billed to HFS and paid at the agreed rate. Mammography services navigation will follow the current BCCP algorithms. Outreach and education to the communities served will be accomplished similarly to the methodology in IBCCP. Community outreach and education will occur at least once every 60 days at events in the community. Staff involved in the outreach and education will be reflective of and speak the language of the community being served. At Mercy a significant African American, Hispanic and Asian community is addressed and therefore staff hired for the project will reflect the community s needs. It will be critical that the staffing represent the community served and that the framework and design of the program meet the expectation of the community i.e.: nurses, social workers or clerical personnel. Enhancements will include providing transportation i.e. Gas cards or bus tokens as necessary for patients to complete the screening cycle. All patients will receive reminder calls to assure that compliance with the mammography plan of care is achieved within 60 days from initial screening. If no physician s order can be obtained the patient will be given an appointment to see a practitioner for a breast exam and an order will be provided for whatever mammography service is necessary. The day after the appointment the result will be assessed by the navigator and the patient will be called and given instructions for appropriate follow up. If the patient needs a biopsy, the navigator will assure that the patient have an order and transportation. The patient will receive a reminder call the day before the biopsy. The day of the biopsy the patient will be given a card and written instructions regarding follow up. Post biopsy if the result is negative then the patient will be called with ordered follow up. The navigator will arrange the appointment and place a reminder call the day before. Post biopsy if the result is positive then the patient will be set up with a surgeon and the navigator will accompany patient and assure that the patient be given written information regarding the plan of care. At this point the breast cancer navigation will begin and the

2 patient will be given to the breast cancer navigator. The breast cancer navigator will assure that all appointments are confirmed for the patient and provide transportation assistance as needed. NCCN guidelines will be followed and if guideline not followed documentation will reflect clinical reason. The breast cancer navigator will assure that the patient has access to the interdisciplinary team and community resources to provide well-coordinated, timely, compassionate care in a high quality cancer program. The patient will be assigned a PCP if one does not currently exist. The patient will be followed by the breast cancer navigator through completion of the oncological plan of care into survivorship. Evaluation of the pilot will need to be designed and all staff will require extensive training to care for the patients and enter data. Monthly reports should be generated and sent to the HFS representative. The evaluation database should assist the navigators at tracking all patients.

3 2. Operational Plan and Budget Mercy Pathway Through Breast Care Mercy Hospital Mammography Navigation Breast Cancer Navigation Eileen Knightly Same Same Project Director Staff Hours RN Case Manager 4 hrs/day x 5 weekdays; Clerical navigators (2) 8 hours /day x 5 week days;?2 data entry staff 8 hours/day x 5 week days Some staff will need to be culturally representative of the community served. Office Location 1 RN Case Manager 4 hrs/day x 5 week days; Clerical navigators (2) 8 hours /day x 5 week days; 1 MSW to provide psychosocial services 8 hrs/day x 5 week days; 2 data entry staff 8 hours/day x 5 week days Some staff will need to be culturally representative of the community served. Mercy Hospital Mercy Breast Center 12 th Floor Mercy Hospital 12 th Floor Year 2 The above navigation plan will continue into year 2 with the addition of a screening mammography machine at a new Mercy FQHC at 37 th and Cottage Grove. This high volume Medicaid community is located in an area of the city with very limited access to medical services since the closing of Michael Reese Hospital. Having mammography services available for the Medicaid patients at the clinic where medical services are delivered will increase access and improve compliance as a one stop shop. This will allow all the patients seen in the clinic same day to same week screening appointments and improve screening rates among this population. Additionally across the street from the clinic a senior center is being constructed and this will improve screening rates for this population.

4 2011 Budget Projections First Year Budget Projections Second Year Salaries/Fringes Estimated caseload Director Clerical Navigators Data Entry Medical Social Worker RN Case Managers Fringes Contractual Office Space design and furniture, computers, printers, scanners, fax, phones, postage, rent, computer software and direct expenses Printing and charts Staff education Supplies patient Education office supplies Mammography Navigation Breast Cancer Navigation Mammography Navigation Hologic Digital Mammography Unit (install and accreditation) for screening at 37 th Cottage FQHC Breast Cancer Navigation

5 Travel Staff gas cards, bus tokens, incentives TOTAL 3. Data Collection Elements: All patients will be assigned PN numbers (pilot navigation) Mammography Data Elements Name, DOB, race, address, phone number, date of screening and result, date notified in writing and by phone, date for next year reminder, barriers encountered (drop down to include: transportation, language, access to PCP) Date of diagnostic mammogram, date of letter sent, date of reminder call, barriers encountered, date of biopsy or date of next follow up mammogram Date of biopsy, barriers encountered, results negative date letter sent out, date telephone contact made, date for follow up mammogram communicated. Date reminder needed. Breast Cancer Navigation Elements In addition to the above Date of surgical consultation, date of PCP appointment, date of surgery, date of oncologist appointment, date chemo started, date radiation started, barriers encountered (shelter, language, transportation, psychological, economic, cultural, child care,) barriers addressed, stage at diagnosis, ACS resources given, support services (social worker, ACS, nutrition, psychological), herceptin appropriate, herceptin given 4. Measuring Outcomes Mammography Data: Complete screening cycle within 60 days

6 Number of Medicaid mammograms billed to HFS in a various month over number of patients entered into pilot navigation system Patient satisfaction survey process for all pilots with data collected and sent to HFS Breast Cancer Navigation Date of diagnosis to date of treatment initiation within 30 days Percent of patients with PCP appointments Clinical staff will be sent to the Educare course for Nurse Navigation. Clerical navigation staff will be sent the Freedman Course. Data entry staff for all pilots will be completed as a unit to assure accurate collection.