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Focus on Quality: Hallmark of Cancer Care at CalvertHealth

New Project Reducing Dental Complications in Multiple Myeloma Patients

“There is no doubt in my mind we significantly improved the quality of care for our multiple myeloma patients by participating in this quality initiative with the Association of Community Cancer Centers (ACCC),” said Dr. Arati Patel, who is the medical director of quality and outreach for oncology services at CalvertHealth.

Multiple myeloma is the second most common hematologic malignancy (cancer of the blood), after non-Hodgkin lymphoma. It is more common in men than women and occurs more frequently after age 70. The disease can damage and weaken the bones, immune system and kidneys.

According to Dr. Patel, CalvertHealth was selected to participate in the six-month collaborative effort with the ACCC along with two other hospitals nationwide. The program brought together CalvertHealth’s multidisciplinary oncology team with visiting experts from top cancer centers across the country to explore barriers and solutions to optimal care for patients diagnosed and treated for multiple myeloma.

“The opportunity to work with the ACCC and to bring all their resources to bear on our improvement project was really exceptional,” said Kasia Sweeney, who oversees oncology services at CalvertHealth Medical Center (CHMC).

Commitment to Quality Underscored

“We have a whole team (our cancer committee) who is constantly reviewing data and evaluating how we care for patients looking for opportunities to make improvements,” added Sweeney.

“Every year, our cancer committee selects one or two quality projects to focus on,” she said. “The physicians make suggestions about potential areas of focus based on their own knowledge of the patient population or different challenges they’ve identified within their practice.”

Sweeney went on to add, “For instance, last year we did a lymphedema project that looked at our patient experience to determine what we could do in terms of enhancing education to provide the best possible outcome.

“Now, all new breast cancer patients are referred to physical therapy for a pre-op evaluation,” she said, “and then followed post-op with measurements to make sure we catch any lymphedema early. “The prior year we did a thoracic study that was highlighted as best practice by the American College of Surgeons Commission on Cancer,” said Sweeney. “This study resulted in us making changes to our biopsy process in order to expedite diagnosis and treatment.”

Dr. Patel also emphasized the effort devoted to ensuring the highest quality cancer care at CalvertHealth Medical Center. “I feel like there is a great partnership between administration and the medical leadership at CalvertHealth,” she said. “I take tremendous pride and responsibility in being charged with the quality initiatives for our oncology program.”

Dr. Patel said this “culture of quality” is the foundation of the patient-centered approach to care at CalvertHealth. “At all times, we want to make sure we’re following the latest evidence-based guidelines, enhancing patient safety, minimizing complications and maximizing value in the health care we deliver.”

Survival Rates Improving

“This quality study was especially important because of the increasing number of multiple myeloma patients who are living longer with newer treatment regimens,” said Dr. Bilal Ahmed, who is board certified in medical oncology and hematology. “It has become one of the more common cancers I treat actually.”

He explained, “Even though the incidence of multiple myeloma is low, the prevalence is high now. Nearly all of the multiple myeloma patients I have seen in the last 10 years are living with what we now call a chronic condition.

“Almost every year, we’re seeing three to four new treatments for multiple myeloma,” said Dr. Ahmed. “Particularly exciting is the research into CAR T cell therapy, which trains your immune system to find and kill cancer.”

He went on to add, “I am very proud of our (oncology) team for incorporating the most cutting-edge treatments as soon as they gain approval.”

Communication and Collaboration Key

According to Dr. Patel, one of the challenges with multiple myeloma patients is effectively addressing the side effects of the bone-modifying agents (BMAs), which are administered to treat the bone-related effects caused by the disease. A chief concern being teeth and jaw problems.

“Unfortunately, dental health for this vulnerable population is a huge issue in Southern Maryland,” said Dr. Patel. “Many do not have dental insurance and there is a shortage of dental providers.”

Dr. Patel said the data collected from the study demonstrates CHMC made a meaningful impact in the quality of care for multiple myeloma patients. “We increased the use of evidence-based bone-modifying agents; we did a better job of screening these patients for dental risk; we monitored them better and the patients were more engaged.”

She said enhanced communication and collaboration were key factors in the project’s success. “We had multiple meetings among the members of the oncology team to make sure we were all on the same page. Additionally, we created multiple tools to make sure these things were happening.”

Infusion center nurse Jennifer Dixon, RN, BSN, agreed with this perspective. “Establishing dental folders and dental screening tools in each myeloma patient’s electronic health record enabled the staff to better assess each patient’s dental health and those at risk for bone-modifying agent complications.”

Dixon went on to add, “The improved order set for bone-modifying agents also helped improve patient safety.”

Dr. Patel recognized the support received from the ACCC during the quality study. “We had constant interaction and support from them. They gave us lots of guidance and feedback. It was a nice collaboration for us.” She went on to add, “Doing these quality studies enables us to bring the most recent, most innovative and cutting-edge strategies
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