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Award Recipients 2012


Quality Award Winner

The CARE (Chronic Ascites & Recurrent Effusion) Program
The Ottawa Hospital
Dr. Kayvan Amjadi, Lynne Kachuik, Glenda Owens, Lorraine Cake

Palliative patients seen in the CARE program usually have an average life expectancy of less than 6 months. These patients were admitted to hospital for an average of 16 days for pleurodesis which failed within 1 month in 2/3 of the cases.
Solution The outpatient CARE Program was developed collaboratively with the CCAC to manage advanced cancer patients with malignant pleural effusions. Under the program, doctors insert a catheter to allow drainage of the fluid in the home setting. Patients referred to the CARE program have a tunnelled catheter inserted under ultrasound guidance in the clinic that uses evidence-based clinical pathways, policies and procedures. A dedicated RN and APN with pager access and voicemail answer any patient or community nursing concerns. Patients are seen in follow up at 2 weeks, six weeks and as needed.
Results Patients have expressed high degrees of satisfaction with the support from clinic staff and community nurses and the rapidity of access to advice if issues arise. The program annually provides care for about 200 patients with a build-up of fluid around a lung, resulting in a savings of 3,200 bed days per year or approximately $3.8 million. A calculation of costs¸ including those incurred by the CCAC and the costs of the CARE program, show a net cost savings to the system of close to $1 million in a year for pleural effusion management.

Innovation Winner

Infirmary Program
Sherbourne Health Centre
Bernadette Lettner, Eric Paquette, Dr. Laura Pripstein

Cancer care in Canada increasingly uses an outpatient or ‘home care’ model for chemo and radiation therapies. Individuals experiencing homelessness, or those with no real ‘home’, face an impossible situation. They have significant barriers to accessing mainstream treatment. Even those in shelters or rooming houses - where up to 50 people may share a dormitory and washroom - lack a sufficiently safe or hygienic environment, and cannot appropriately dispose of the toxic chemotherapeutic waste.
In 2011, Sherbourne Health Centre Infirmary expanded its services for Clients with cancer, including end-stage cancer, to include those actively undergoing treatment. Clients receiving chemotherapy or radiation now regularly represent 20% of available bed-space. Due to the nature of chemotherapy and radiation treatments, Clients are guaranteed beds and can be re-admitted as often as necessary over the course of treatment. Existing partnerships with CCAC ensure nurses administer IV chemotherapies for Clients as in home- care situations.
Results Since 2011, the Infirmary has enabled Ontario oncologists to confidently implement treatment plans for a number of homeless or vulnerably housed individuals, who may otherwise have been refused treatment or struggled to fit into care options. The initiative has produced integrated care from a coordinated team of CCAC, oncologists and Infirmary staff, to ensure a seamless transition between hospital, shelter and infirmary settings. This has resulted in improved outcomes for Clients, with strong continuity of care and a truly client-centred approach. From a patient’s point of view, the bright, welcoming Infirmary and respectful approach of everyone in the Centre, are part of an often life-changing experience for Clients, who regularly describe receiving unprecedented quality of care. Most have experienced significant mistreatment and stigma, and are mistrustful of the health care system - the importance of them receiving treatment in a client-centred environment that treats them respectfully and holistically cannot be underestimated.

Honourable Mentions

Quality Award Honourable Mention

Prostate Cancer Rehabilitation Clinic
Princess Margaret Cancer Centre, University Health Network
Andrew Matthew, Leah Jamnicky, Kristen Currie, John Trachtenberg, Neil Fleshner, Carlos Marales, Shabbir Alibhai, Antonio Finelli, Girish Kulkarni

Background Approximately 25,000 Canadian men are diagnosed with prostate cancer, and approximately 4000 men die of the disease annually. This corresponds to an additional 21,000 Canadian prostate cancer survivors each year, who on average have an expectant life span of 20 years. This survival rate is at the cost of treatment related morbidity. Prostate cancer patients and their partners report that sexual dysfunction has the single greatest negative impact on their health-related quality of life of any other treatment side-effect or survivorship issue.
Solution The Rehab Clinic is North America’s first Biospsychosocial Prostate Cancer Rehabilitation Clinic (the Rehab Clinic) to reduce the burden of treatment-related morbidity and improve the patient/partner survivorship experience. The Rehabilitation Clinic program leverages multidisciplinary teams to help patients and their partners achieve optimal sexual health and restore their health-related quality of life.
Results The responsibility for post-treatment sexual dysfunction care has been transferred to a specialized group of multi-disciplinary professionals to address sexual dysfunction post-treatment. The Rehab Clinic is introduced pre-operatively as part of usual care in an effort to ensure the patient experiences a continuity of care during the pre- to post-surgery transition.

Innovation Award Honourable Mention

Colorectal Cancer Survivorship Program
North York Family Health Team, North York General Hospital
Taras Rohatyn, Dr. Tim Rutledge, Dr. Daryl Roitman, Dr. Kimberly Wintemute, Dr. Virginia Griffin, Anna Tupis, Dr. Stan Feinberg, Dr. Peter Stotland, Phyllis Ryall, Jennifer Tiberio, Clea Lang, Amanda Hodges, Marjan Moeinedin, Natasha Ramnanan

Background existing models of care for colorectal cancer survivors often means duplicate specialist visits and sometimes duplicate testing for similar purposes which is costly to the health care system. For patients, these duplicate visits are inefficient as they lead to increased time away from work, volunteer activities, and family commitments.
Solution The North York Family Health Team Colorectal Cancer Survivorship Program is a collaborative partnership with North York General Hospital (NYGH) which was launched on April 4th 2012 after one year of planning and preparation. It is a nurse practitioner-led (NP) cancer survivorship program for patients who have completed active treatment for colorectal cancer and require five year surveillance for cancer recurrence or metastases.
Results The program has reduced duplication of care provided by multiple specialists, resulted in fewer specialist appointments billed to OHIP, reduced costly duplication of tests and streamlined care into one location provided by one healthcare professional. The program has shifted the roles in survivorship care from a physician-driven hospital model to a community based NP-led environment.

Nurse practitioners are given the opportunity to provide meaningful care to their full scope of practice. The introduction of the program has also led to an improvement in patient-centred and holistic care for colorectal cancer patients.