Froggy Bottom: Oncology Haley Brown, Ryan Cusack, Kait Donovan, Emily Hutzayluk, Kathleen O’Neill, Gemma Rosas, Jimmy Ruble

What’s the Problem? 1

●

● ●

Statistics of cancer around Frederick, MD1 ○

Frederick County: 437.9 per 100,000 individuals

○

Washington County: 466.0 per 100,000 individuals

Cancer survivors report much lower health related quality of life when compared to population norms In 1,822 adults with a history of cancer, 24.5% reported poor physical health and 10.1% percent reported poor mental health 2

What’s the Problem? 1

● ● ●

Physical impairments include soft tissue, strength, range of motion, pain 3 65% of patients undergoing outpatient cancer treatment described having functional problems related to ADLs. 4 A Meta-analysis found that exercise improves physical function, QOL, and cardiovascular fitness while decreasing cancer-related fatigue in patients across the spectrum of cancer diagnoses 5

Our Mission Provide adults currently receiving or who have undergone chemotherapy and/or radiation with a comprehensive, interdisciplinary care experience that will address their quality of life goals.

2

Vision 3

Our program aims to build a community for both caregivers and patients with current or past cancer diagnoses. We offer an interdisciplinary team under one roof that is focused on providing rehabilitation services with an option of individualized and/or group sessions focused on maximizing quality of life. With the incorporation of technological services such as telehealth and a clinic-personalized application, patients and caregivers have increased accessibility to managing their care.

Froggy Bottom: Unique Program Structure ● ●

●

Step 1: Patient is referred to Froggy Bottom Oncology by primary oncologist. Step 2: Patient is contacted via telephone by social worker. ○

Subjective history taken.

○

Formally screened with tools developed by each clinician to determine which services will most benefit the patient.

Step 3: Begin in-person evaluation process with most appropriate provider(s). ○

●

Following the evaluation, the social worker will orient to patient portal and telehealth.

Step 4: Interdisciplinary communication to create a comprehensive plan of care without duplication of services.

Froggy Bottom Oncology - Novelty in Healthcare ● Patient-centered Care ○ Following consult with our neighboring oncology team, patients will be contacted and formally screened by our social worker to determine, in conjunction with the patient, which services will best benefit them. ○ All patients and their caregivers will be offered access to group and individual counseling sessions (separate or combined for patient and/or caregiver) and group wellness classes.

Froggy Bottom Oncology - Novelty in Healthcare ● Improved Access to Care ○ Each patient will have an online application (accessible through a smartphone or computer), which will assist in providing: ■ Appointment reminders. ■ Notifications about upcoming events at Froggy Bottom Oncology or in the community. ■ Access to the electronic medical record. ■ Access to telehealth services pending change in status or transportation barriers.

Froggy Bottom Oncology - Novelty in Healthcare ● Decreased System Waste ○ All healthcare providers on the rehabilitation team will be working in the same office, thereby decreasing the need for separate appointments, prescriptions, and extensive re-evaluations to receive services from another provider. ○ An integrated electronic medical record between Froggy Bottom Oncology and our neighboring oncology team will improve communication between providers and ensure parallel, informed decision-making from everyone on the team.

Interdisciplinary Team: Rehabilitation Physical Therapists (3 full-time)6 ●

Movement and function specialists ○

Patients going through cancer treatment may experience a wide variety of impairments and symptoms ■

○

●

E.g. Functional impairments, pain, deconditioning, fatigue, etc.

Evaluate and treat patients who are deemed appropriate by the social worker

Develop and facilitate group exercise sessions

Interdisciplinary Team: Rehabilitation Occupational Therapists (2 full-time)6 ●

Focus on activities of daily living and occupational tasks ○

Cancer can impact a person’s ability to participate in self-care, ADLs, and their occupation

Speech Language Pathologist (1 per diem)6 ●

Cancer of the head/neck can have an impact on a patient’s cognition, ability to communicate, and feed themselves. ○

Estimate ~8 hours/week on site for evaluations and treatment sessions

Interdisciplinary Team: Social Work & Mental Health Social worker (1 full-time)6 ●

Initial evaluation via phone call to determine appropriate services

●

Provide care coordination between physical and mental health services to serve as a direct line of communication for patients and caregivers.

Psychologist (community partnership; paid per diem) 6 ●

Providing convenient access to group therapy/ mental health support services.

Interdisciplinary Team: Dietitian Dietitian (community partnership; paid per diem)6 ●

Provide education and counseling via seminars for patients experiencing challenges or changing needs for nutritional health throughout the cancer treatment process. ○

2-3x/month group seminars

4

Interdisciplinary Team: Marketing Specialist Marketing Specialist (1 part-time)6 ●

Hired to create and manage a marketing campaign for Froggy Bottom. ○

● ● ●

20 hours/week

Organize marketing projects and events Maintain partnered relationships Manage social media for Froggy Bottom

Interdisciplinary Team: Non-Clinical Staff Receptionists (2 full-time) ●

Role in administrative tasks ○

Billing, scheduling, etc.

Cleaning staff (1 part-time) ●

Cleaning services to the clinic 3x/week

Total Workforce Costs6

All salary data from US Bureau of Labor Statistics (bls.gov)*

Clinic Design

Location At a glance

Proposed location: 7 Frederick, MD in the existing building of Frederick Oncology Hematology Associates, P.C Accessibility: Highway access: Route 15 near the intersecting point of Route 26 and 355

A closer look

5

Nearby interstate 70 offers access to Hagerstown, MD and Baltimore, MD and interstate 270 offers access to Washington, DC Public transportation: Frederick Transit Center bus line

Community & Target Population 8,9

(U.S. Cancer Statistics Working Group, 2016)

(Frederick Memorial Hospital et al., 2016)

Community & Target Population 10,11 Frederick, MD

Hagerstown, MD

Total Population

69,479

40,432

-Race and Hispanic Origin

White: 63.9% Black: 18.6% Latino/Hispanic: 14.4% Two or more races: 4.0% Asian: 5.8%

White: 75.8% Black: 15.5% Latino/Hispanic: 5.6% Two or more races: 5.1% Asian: 1.3%

Foreign born: 19.3%

Foreign born: 6.8%

Ages

<5 yo: 7.7% <18 yo: 23.7% 18-65 yo: 57.8% >65 yo: 10.8%

<5 yo: 8.7% <18 yo: 25.8% 18-65 yo: 53.2% >65 yo: 12.3%

Education (>/= Bachelor’s degree)

37.6%

17.1%

Work Status (over 16 yo)

73.2%

65.8%

Median Income/ Poverty

$65,967 year 10.8% in poverty

$38,080/ year 26.1% in poverty

-Self Identify as “Foreign Born”

(U.S. Census, 2015)

Community & Target Population 10,11 Frederick, MD

Hagerstown, MD

Total Population

69,479

40,432

-Race and Hispanic Origin

White: 63.9% Black: 18.6% Latino/Hispanic: 14.4% Two or more races: 4.0% Asian: 5.8%

White: 75.8% Black: 15.5% Latino/Hispanic: 5.6% Two or more races: 5.1% Asian: 1.3%

Foreign born: 19.3%

Foreign born: 6.8%

Ages

<5 yo: 7.7% <18 yo: 23.7% 18-65 yo: 57.8% >65 yo: 10.8%

<5 yo: 8.7% <18 yo: 25.8% 18-65 yo: 53.2% >65 yo: 12.3%

Education (>/= Bachelor’s degree)

37.6%

17.1%

Work Status (over 16 yo)

73.2%

65.8%

Median Income/ Poverty

$65,967 year 10.8% in poverty

$38,080/ year 26.1% in poverty

-Self Identify as “Foreign Born”

(U.S. Census, 2015)

Key differences The population of Frederick in general: ● Is much more ethnically diverse ● Has more formal education beyond high school ● Has a higher income and lower rate of poverty

What is currently available? Available Physical Therapy Frederick and Hagerstown, MD region 12 ●

10

1

31 Physical therapy clinics 10 ○

6

Specializations only includes sports medicine, manual therapy and women’s health

●

4 out of the 31 clinics offer lymphedema and scar mobilization for cancer patients

●

Only true rehab center is Meritus Medical Center

3

1

6

Our Competition Meritus Medical Center13 ● ●

In partnership with John R. Marsh Cancer Center Provides rehabilitation services specialized for the oncological population

8

7

How does Meritus compare to Froggy Bottom?

Community Partnerships ●

American Cancer Society Transportation Program 9

●

Ananda Shala Yoga and Pilates

●

Savor Health 10

11

Community Partnerships

9

American Cancer Society Transportation Program Transportation program in which volunteers provide patients with rides to and from their appointments

●

●

Oncology certified dieticians create meal plans tailored to patients’ treatments/medications

●

Offerings include yoga, Pilates, massage, meditation, and Reiki

Savor Health Meal delivery program specifically catered to the needs of people with a cancer diagnosis 10

11

Ananda Yoga Shala 4 miles away from clinic, offers patients’ a variety of low impact exercise options and activities to promote relaxation

Major Benefits Decrease caregiver burden

Capital Expense: Bridge Patient Portal14

12

Capital Expense: Bridge Patient Portal ●

●

14

This technology includes ○

A care provider interface that can integrate an existing EHR system

○

A patient portal that is accessible via web browser, smartphone, or tablet for both Mac or PC devices.

Largest benefits: ○ ○ ○ ○ ○

Access their care plan online Access their personal health records Forms and outcome measures can be provided and filled out via the portal Request appointments on the portal Telehealth can be provided through secure messaging or video calling

Bridge Patient Portal

14

We envision the app’s homepage promoting: ● ● ● ●

Appointment reminders Upcoming events Telehealth Direct access to personal health information

The app is customizable and can change based on consumer feedback

12

Bridge Patient Portal: Budget

14

Budget: $15,854 total ● ● ●

One time fee: $9,950 for 1-10 providers and 9,000 patients/users (no warranty included) Optional Maintenance: $3540 ($295/month) Staff training (8 hour): $2364 for paying Froggy employees for unskilled work while they are being trained. ○

Training provided free from the company

Measuring Success: Patient Outcomes Step 1: Collect Validated Outcome Measure Data For Every Patient Quality of Life Measures

Functional Activity Outcomes

SF-36

6-Minute Walk Test

Fatigue Severity Scale

Gait Speed Patient-Specific Functional Scale

Measuring Success: Patient Outcomes

15,16,17,18

Step 2: Analyze Patient Outcome Data with Treatment Variables ● ● ●

Type of cancer Stage of cancer Point of care when referral was received ○

● ●

(Pretreatment, during treatment, posttreatment)

Type of treatment(s) being received (chemo, radiation…) Presence of surgery

Cancellations

Application usage

No shows

Telehealth usage

Hospital Readmission Hospital Readmission

Total Number of Falls

In-house Cost Tracking: Dashboard 15,16,17,18

Measuring Success: Cost

15,16,17,18

Part 1: Compliance Data

Cancellations

No shows

Measuring Success: Cost Part 2: Utilization of Services

Telehealth usage

Application usage

Group Wellness utilization

Measuring Success: Cost

15,16,17,18

Part 3: Preventing Secondary Complications

Hospital Readmission

Total Number of Falls Reported

Hop into Better Health! ● Physical Campaign ○ Churches ○ Salons ○ Libraries ○ Grocery stores ○ Community Fitness ○ Baltimore County Cancer Coalition/ACS

● Digital Campaign ○ Social Media (#FroggyHealth) ○ Print Media ○ Froggy resources ○ Exclusive membership

Membership ●

Tadpole TeamTM ○ Exclusive access ○ Coupons/discounts

●

Polliwog PointsTM ○ Attending events ○ Using partnered services ○ Testimonials

●

Program Benefits ○ Increase patient attendance ○ Prioritize Froggy Bottom on search engines ○ Encourage community ○ Assist lower socioeconomic status

13

References 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.

13. 14. 15. 16. 17. 18.

Maryland Department of Health and Mental Hygiene Frederick Country Health Department. Investigation of Cancer Concerns in Frederick, Maryland: Summary Report. October 3, 2011. Available at: http://phpa.dhmh.maryland.gov/IDEHASharedDocuments/Frederick_SummaryReport. Accessed December 4, 2016. Weaver KE, Forsythe LP, Reeve BB, et al. Mental and physical health-related quality of life among U.S. cancer survivors: population estimates from the 2010 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev. 2012;21(11):2108-17. Alappattu M, Coronado R, Lee D, Bour B, George S. Clinical characteristics of patients with cancer referred for outpatient physical therapy. Physical Therapy. April 2015;95(4):526-538. Available from: MEDLINE Complete, Ipswich, MA. Accessed November 15, 2016. Cheville AL, Beck LA, Petersen TL, et al. The detection and treatment of cancer-related functional problems in an outpatient setting. Support Care Cancer. 2009;17:61–67. Mayer, Samuel Chapter 55: Rehabilitation of Individuals with Cancer. In: Niederhyber, John eds. Abeloff’s Clinical Oncology. 5th ed. Churchill Livingstone; 2014:806-812. Bureau of Labor Statistics. Occupational Employment Statistics. US Department of Labor website. http://www.bls.gov/oes/home.htm. May 2015. Accessed December 1, 2016. Frederick Oncology Hematology Associates, PC. http://www.myfoha.com/. Accessed Dec 2, 2016. Frederick Memorial Hospital and County Health Department. Frederick County 2016 Health Assessment. http://health.frederickcountymd.gov/DocumentCenter/View/1470. Accessed Dec 4, 2016. U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2013 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2016. www.cdc.gov/uscs. Accessed Dec 4, 2016 Census Bureau. Census Information: Hagerstown MD. http://www.census.gov/quickfacts/table/PST045215/2436075. Accessed November 9, 2016. Census Bureau. Census Information: Frederick MD.. http://www.census.gov/quickfacts/table/PST045215/2430325,51630 . Accessed November 9, 2016. Googlemaps: PT clinics in Frederick https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#safe=active&q=physical+therapy+clinics+in+frederick+md&rflfq=1&rlha=0&rllag=3966162 4,-77712620,3187&tbm=lcl&tbs=lf:1,lf_ui:2,lf_pqs:EAE. Accessed December 1, 2016. John R. Marsh Cancer Center. Meritus Cancer Services. Meritus Health website. http://www.meritushealth.com/Our-Services/Cancer-Services/Overview.aspx. Accessed December 3, 2016. Bridge Patient Portal. Jan 2015. www.bridgepatientportal.com. Accessed Dec 2, 2016. Price RA, Stranges E, Elixhauser A. Cancer Hospitalizations for Adults, 2009 . HCUP - Healthcare Cost and Utilization Project . February 2012. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb125.jsp. Accessed December 3, 2016. Overcash J, Rivera H, Van Schaick J. An Analysis of Falls Experienced by Older Adult Patients Diagnosed With Cancer. Oncology Nursing Forum [serial online]. September 2010;37(5):573-580. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed December 3, 2016. Burns EB, Stevens JA, Lee RL. The direct costs of fatal and non-fatal falls among older adults—United States. J Safety Res 2016:58. Accessed December 3, 2016. l, N. V., Slattum, P. W., & Cox, F. M. (2005). The cost of falls among the community-dwelling elderly. J Manag Care Pharm, 11(4), 307-16. Accessed December 3, 2016.

Image References 1. 2. 3. 4. 5.

6.

7. 8. 9.

10. 11. 12. 13.

Problems Ahead sign. http://www.johnhembree.com/wp-content/uploads/2015/09/Problems-Ahead.jpg Accessed November 10, 2016. Rounding image. http://www.assesspatients.com/uploads/2/0/4/8/20485216/1628295.png Team image. https://www.netlanguages.com/platform/info/media/images/individuals/individuals.png Accessed November 14, 2016. Variety of Spices image http://www.oakvillesandbox.com/wp-content/uploads/2015/09/nutrition.jpg Accessed November 9,, 2016. Google Maps Hagerstown. https://www.google.com/maps/place/Hagerstown,+MD/@39.6367414,-77.7927435,12z/data=!3m1!4b1!4m5!3m4!1s0x89c9ed151481df dd:0x65f2620826df7239!8m2!3d39.6417629!4d-77.7199932 Accessed November 14, 2016. Google Maps PT Clinics in Hagerstown. https://www.google.com/maps/search/hagerstown+md+physical+therapy/@39.6369637,-77.7927435,12z/data=!3m1!4b1 Accessed December 2,, 2016. Meritus Logo. http://www.meritushealth.com/images/Pharmacy-Residency-Program/Cable_MCA_WCHS_631L_2239[1].jpg Accessed November 30, 2016. Meritus image. http://www.noventri.com/blog/wp-content/uploads/2014/03/MeritusLogo-300x254.jpg Accessed December 3, 2016. ACS Logo. https://upload.wikimedia.org/wikipedia/en/thumb/4/47/American_Cancer_Society_Logo.svg/1280px-American_Cancer_Society_Logo.s vg.png Accessed December 3, 2016. Ananda Shala Logo. http://www.anandayogashala.com/wp-content/uploads/2016/04/new-logo1.jpg Accessed December 3, 2016. Savor Health Logo. http://savorhealth.com/wp-content/uploads/2016/02/savorhealth_logo.png Accessed December 3, 2016. App images. http://www.bridgepatientportal.com/img/bridge-lab-tracking.67886639f39d83af.png Accessed November 20, 2016. Frog image. http://frogdice.com/wp-content/uploads/2012/04/Nubbles500X500.png Accessed November 30, 2016

Image References 9. ACS Logo. https://upload.wikimedia.org/wikipedia/en/thumb/4/47/American_Cancer_Society_Logo.svg/1280px-American_Cancer_Society_Lo go.svg.png Accessed December 3, 2016. 10. Ananda Shala Logo. http://www.anandayogashala.com/wp-content/uploads/2016/04/new-logo1.jpg Accessed December 3, 2016. 11. Savor Health Logo. http://savorhealth.com/wp-content/uploads/2016/02/savorhealth_logo.png Accessed December 3, 2016. 12. App images. http://www.bridgepatientportal.com/img/bridge-lab-tracking.67886639f39d83af.png Accessed November 20, 2016. 13. Frog image. http://frogdice.com/wp-content/uploads/2012/04/Nubbles500X500.png Accessed November 30, 2016