Gina M. Villani, MD, MPH
In 2016 and 2017, a team from The Ralph Lauren Center for Cancer Care (RLCCC) is participating in an ASCO Quality Improvement Grant program, which is supported by the Stavros Niarchos Foundation. The grant program aims to improve the delivery of cancer care in medically underserved communities by increasing access of participating practices to ASCO’s quality improvement resources. Each participating practice is required to complete ASCO’s Quality Training Program (QTP) and Quality Oncology Practice Initiative (QOPI®).
The Conquer Cancer Foundation, the philanthropic arm of ASCO, was awarded and administers the grant, which is for nearly half a million dollars over the next 2.5 years. As part of the grant, practices will receive an onsite assessment, assistance in identifying achievable improvements, targeted toolkits, and hands-on quality improvement training. They will each partner with a mentor practice that will assist with specific areas of quality improvement. Outcomes of the project will be reported at the ASCO Annual Meeting, the ASCO Quality Care Symposium, and in the Journal of Oncology Practice.
The comprehensive, 6-month QTP, which recently held its second learning session at ASCO headquarters in Alexandria, Virginia, is designed to train oncology health-care providers to investigate and implement data-driven quality improvement and manage clinical and administrative processes and outcomes. The program brings oncology teams together to create and facilitate an improvement project. Each team selects a project that will solve a problem in its own clinical setting, so the learning experience is simultaneously fostering a solution or best practice.
QOPI® is an oncologist-led, practice-based quality assessment program designed to promote excellence in cancer care by helping practices create a culture of self-examination and improvement. It provides a standard methodology; robust library of quality metrics for oncology; and a collection tool to reliably and routinely assess care, inform quality improvement activities, and demonstrate quality to patients and external stakeholders.
Below is an interview with RLCCC CEO and Medical Director Gina M. Villani, MD, MPH, in which she discusses the RLCCC, her team’s experience with the QTP and QOPI, and the quality improvement project they are working on as part of the QTP.
Conquer Cancer Foundation: Tell us about the Ralph Lauren Center for Cancer Care and the patients you serve.
Gina M. Villani, MD, MPH: The RLCCC was founded in Harlem [in New York City] more than a decade ago in combination with the nation’s leading cancer center, Memorial Sloan-Kettering Cancer Center, to fight a fundamental inequity in the American health-care system: African Americans and Latinos, people in poverty, and those without adequate health insurance die more frequently from cancer than others. Since its inception, the RLCCC has cared for approximately 100,000 patients and 13,000 uninsured individuals from all five New York City boroughs. RLCCC is the only outpatient facility of its kind in Harlem, where its specialists make treatment possible for a wide range of cancers.
The Center’s mission is to provide excellent, compassionate cancer prevention, diagnosis, and treatment to all. The majority of the patients seen at the RLCCC are African American or from Hispanic and Asian backgrounds, with multiple comorbidities, including diabetes, obesity, and substance abuse. Eighty-five percent are Medicaid or Medicaid-managed patients. The other 15% are uninsured or think they are; we are usually able to help half of that 15% obtain health insurance coverage.
At the heart of the Center’s work is our pioneering care navigation model, through which we deliver a comprehensive, more personalized approach to care that goes beyond treatment. When an individual visits the Center, he or she is partnered with a pair of patient navigators: a clinical nurse navigator who explains procedures, side effects, medication, and treatment options; and a lay navigator, who solves problems on issues from child care to support groups, transportation, and psychotherapy. Through navigators, patients access our onsite services, including a food pantry, a nutrition program, a smoking cessation program, monthly legal clinic, and support for insurance enrollment.
CCF: Why did you decide to apply for ASCO’s Quality Training Program? What expanded knowledge and/or objectives were you hoping to achieve when you applied?
GV: We decided to apply for this program to ensure that physicians who see and treat underserved patients focus on not only providing care, but the highest quality care. Throughout my experience working at the RLCCC, I have learned that there is a belief that care and quality are different. The RLCCC’s mission emphasizes patient-centered care that is inclusive of all. Health outcomes for the uninsured and underserved are well-documented to be significantly poorer than health outcomes for their privately insured counterparts. Underserved patients receive less medical care and often receive lower quality medical care.
We realized there were some gaps that presented areas of opportunity to better serve our patients. We want to make sure all of our patients receive the same care—or better care—as a patient who has private insurance would. We also want to provide quality training to our clinicians to make sure service improvements are conducive to our patient’s needs.
CCF: Describe your team and why you chose these members to serve on this quality improvement grant project.
GV: Our project team is made up of Lisa Pfail, our Director of Clinical Services; Nurse Navigators Dorota Stypulkowska and Margaret Bediones; our resident (oncologist) Madhuri
Devabhaktuni, MD; and me, as CEO and Medical Director of the Center.
I chose these members to serve on this project because they have consistently gone above and beyond in making sure they are always present in a patient’s cancer journey at the Center. Their compassion and understanding of how the quality of care provided to cancer patients influence a patient’s journey and outcomes have been integral to our success at the Center. This team not only makes sure our patients have all of the resources they need since walking through our doors, but they share their passion and commitment to the rest of the staff at the Center. They are truly our best advocates and ambassadors in and out of the center and are respected by both patients and staff.
Further, each member possesses the qualification, experience, and interest needed to understand that quality care is ever-evolving and that there are many elements that can affect the way we provide care and treat patients.
CCF: Please describe the quality project your team is working on. Why was this quality project selected?
GV: Our team is working on measuring and acting on emotional distress in the underserved cancer population. There is no documented direct correlation between mortality and emotional distress, but we know it’s a main concern in reaching treatment compliance. For the population we serve, the risks of having emotional distress are higher—most come from poor neighborhoods and have low educational attainment, and some have sick relatives other than themselves in their household. These factors can increase emotional distress, which ultimately can affect a patient’s likelihood of follow-through and completion of necessary treatment.
CCF: What is the current status of the project and when will the project be completed?
GV: We are utilizing a standardized tool to measure emotional distress and assigning an emotional distress “grade.” Our lay and nurse navigators address each patient’s needs by looking at the score and then referring the patient to the appropriate service to mitigate distress. In many instances our staff can alleviate some of these strains by having our patients meet with our nutritionist or financial navigator; by helping them with transportation; and by giving them healthy food. We are in the process of applying for funding to support an in-house social worker who will provide emotional support and guidance to our patients and their family members.
CCF: What does success look like to you and your team?
GV: Success means that all members of the RLCCC team will understand the importance of addressing emotional distress—that it will become another vital sign for all patients, and that we will develop innovative ways of helping patients cope with and mitigate their stress.
CCF: Please describe your experience with QOPI so far. What are some of the challenges your team has faced? What aspects of the program are your team enjoying?
GV: This is an interesting question because I believe the RLCCC team is enjoying dealing with the challenges of the rigor that comes with measurement and reporting. We have particularly enjoyed the camaraderie present among the group of institutions participating in this project and the exchange of best practices across boundaries. It has been very rewarding to share experiences and lessons learned and to build excitement around quality improvement within a group that has the potential to impact care models across the nation.
CCF: What have you and your team learned from chart abstraction and QOPI participation?
GV: Through QOPI participation, our team has been able to learn where some of our weaknesses lay and to identify gaps in our care model.
CCF: What impact has this grant program had on staff, culture, and your professional development?
GV: This grant program has provided our staff with tools and resources to carry out a quality project. It has also improved RLCCC’s capacity for continuous learning and improvement, while expanding its model of care.
CCF: How will this work be sustained?
GV: We hope that as payment reform is underway, insurers will recognize the need to reimburse essential services such as dealing with emotional distress and providing social work services. In addition, we are always looking to foundations and individual donors to assist in projects that enhance the patient experience. I am sure that we can find funders who are interested in embedding and sustaining quality improvement.
CCF: Would you recommend this quality improvement grant program to other practices/institutions? Why or why not?
GV: Yes, I would recommend this grant program to institutions and practices committed to learning and identifying new opportunities and service improvements, embedded in a culture of quality care. ■
Originally featured in the Conquer Cancer Foundation Newsroom. © American Society of Clinical Oncology. “ASCO Quality Improvement Grant Spotlight: The Ralph Lauren Center for Cancer Care.” www.conquer.org. All rights reserved.