A Sterling Example of NWP’s Hallmark: Coordinated, Integrated Care

June 5, 2018

Colleagues are praising the quick response of Northwest Permanente Oncologist Daniel Da Graca, MD, who recently contacted a Kaiser Permanente member within one hour of her receiving a worrisome scan.

Earlier this spring, nurse practitioner Laura Harris received a CT result that strongly suggested metastatic cancer as the cause of a 45-year-old woman’s GI symptoms. Following a new protocol developed recently by a pair of NWP physicians, Laura immediately contacted the oncology department, where Dr. Da Graca was on call.

Dr. Da Graca confirmed that the scan did show liver lesions, as well as lymph and possible spine involvement. He advised that the next step would be a biopsy of the liver lesions. Laura called the patient, explained what Dr. Da Graca had seen and recommended, and advised her that he would be in touch.

In fact, Dr. Da Graca called the patient almost immediately.

The patient, Laura, and the patient’s primary care physician, Chief of Family Medicine Nilana Gunasekaran, all expressed gratitude to Dr. Da Graca for his prompt and thorough attention.

“Dr. Da Graca went above and beyond,” said Phoebe Harvey, MD, Chief of Hematology/Medical Oncology and Medical Director of the Cancer Service Line.

Exemplary care

The new protocol is a great example of the coordinated, integrated care that is a hallmark of Permanente Medicine – and shows just one of the ways in which our physicians have come together to make the care experience a better one for KP members.

Here’s how it evolved: About a year ago, at Medicine and Management, an inter-regional program to support emerging KP leaders, Dr. Harvey met Dr. Caroline King-Widdall, a family medicine doctor and physician in charge at Keizer Station Medical Office in Salem, Oregon. Their conversation eventually revealed a common goal: to give cancer patients the best care they could at a very vulnerable time — while at the same time helping primary care physicians do their jobs better.

Within a year they would develop the Metastatic Scan Workflow. Per the new protocol, primary care physicians now notify the medical oncology department immediately when a patient receives a scan that suggests metastatic cancer.

A medical oncologist, in turn, orders the necessary tests and lab work, expediting requests for imaging, for biopsy, and for specialized testing by pathologists. Beyond that, the medical oncologist lays out the what and the why for the primary care physician – so he or she can better inform the patient about what to expect. (In Dr. Da Graca’s case, he also called the patient.)

Before this workflow was implemented, the patient’s primary care physician would order testing, a process that could take as long as a couple of months. During that time, the patient would have no contact with the oncology department, and the primary care physicians could offer the patient little in the way of specialized information – adding to what already is a stressful time.

Internal medicine physician Jennifer Brady, MD, physician in charge at Interstate, said that the new protocol has been “a game-changer for us and our patients.”

“Patients are so grateful,” acknowledged Dr. Harvey. And with the involvement of the medical oncology department earlier in the process, “primary care doctors have expressed a sense of relief.”

Dr. Daniel Da Graca is an NWP oncologist.

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