PP308 – Nurse Case Managers in a Multidisciplinary Clinic for Cancer Patients
The Neurological Multidisciplinary Care Clinic (MdCC) at Memorial-Sloan Kettering (MSK) was formed in an effort to foster a new model of care for complex oncology patients with primary and metastatic central (CNS) cancers. The clinic is based on the nationally recognized clinic model used in treatment of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. The specific aims of the clinic are two fold. One aim is to define the needs of frail patients with CNS cancers undergoing cancer-directed treatment utilizing the validated Quality of Life (QOL) and symptoms questionnaires specific to patients with CNS cancers and KPS data to identify and understand patients’/caregivers’ needs: physical, psychological, financial and existential. The second aim is to determine whether this clinic will improve patients’/caregivers’ QOL, patients’ functional status and decrease the rate of unanticipated hospital admissions. The Affordable Care Act encourages the adoption of patient-centered models of care with an emphasis on quality and coordination of care. The role of the nurse case manager in MSK’s Neurological MdCC is aligned with the very core of case management. As part of a collaborative team consisting of a neurologist, neurology nurse, physiatrist, palliative care physician or nurse practitioner, physical and/or occupational therapist, social worker, nutritionist and chaplain the nurse case manager practice is fully aligned with the standards of practice of a professional case manager. The case managers’ presence at time of clinic visit allows for real time assessment of patient and support system, multidisciplinary team collaboration, planning, coordination of community services and implementation of a safe patient centered plan of care with continued observation as warranted.
1. To define the needs of complex patients with CNS cancers
2. To determine whether the clinic will improve patients’/caregivers’ Quality of Life, patients’ functional status and decrease the rate of unanticipated hospital admissions
3. Explore and define the role of the Nurse Case Manager in a Multidisciplinary clinic