|
|
|
|
|
|
|
|
|
|
|||||||
 |
 |
 |
 |
|||||||||
|
Meeting the Rising Demand for Outpatient Care
It wasn’t long ago that hospitalization was routine for most cancer treatments. Two decades ago, a mastectomy meant at least a week’s hospital stay, and even chemotherapy was considered an inpatient treatment. But lengthy hospital stays are largely a thing of the past. Today, cancer patients receive much of their care as outpatients—a trend that many see as benefitting both patients and payers. In recent years, treatment advances and the creation of multidisciplinary outpatient care centers have enabled increasing numbers of M. D. Anderson patients to receive their treatments in a safe, comfortable, and convenient outpatient setting. Now, a new outpatient treatment building scheduled for completion in March 2005 will even further expand the center’s ability to provide high-quality outpatient care designed with patient convenience in mind. The trend toward outpatient care “Much of the move toward outpatient care in this country has been driven by third-party payers in an effort to control expenses,” said Michael S. Ewer, M.D., special assistant to the vice president and chief medical officer at M. D. Anderson. “But this change has been perhaps one of the benefits of managed care, in that it has challenged healthcare providers to find safe and effective ways to deliver care on an outpatient basis, which is clearly to the benefit of our patients.” In fact, when given a choice, the overwhelming majority of patients with cancer would prefer not to be hospitalized. “If I ask people whether they want to come in to the center for five days in a row to get chemotherapy on an outpatient basis or be admitted for the whole five days, probably 90% of them would prefer to come in daily,” said Carmen P. Escalante, M.D., an associate professor in the Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care. In addition to the benefits it affords patients, outpatient care is becoming more and more necessary for logistical reasons—a chronic shortage of inpatient hospital beds. “It’s a significant problem in hospitals throughout the country,” said Dr. Escalante. “One way to deal with the overload is to treat as many patients as possible in the outpatient venue and save our inpatient beds for the very sick patients with complicated cases.” Treatment advances Another reason for the increase in outpatient care has been the development of equipment and treatment advances that are as effective but less invasive and debilitating than previous treatments. “At M. D. Anderson, we have found ways to treat patients on an outpatient basis that would have been considered absolutely unfeasible years ago,” said Dr. Ewer. One example is the 23-hour mastectomy. According to Raphael E. Pollock, M.D., Ph.D., division head and a professor in the Department of Surgical Oncology, “Twenty years ago, if you were having a mastectomy, you were an inpatient for eight days, and now it’s routinely done as outpatient surgery.” Studies show that outpatient surgery can be performed safely, effectively, and to the patient’s satisfaction by careful coordination of inpatient and outpatient services. In fact, last year over a third of the surgeries performed at M. D. Anderson were done on an outpatient basis. Significant advances in chemotherapy administration have also made it possible to offer outpatient treatment to more patients. Previously, extremely sedating drugs used to control common chemotherapy side effects such as nausea and vomiting made hospitalization a necessity. Now, newer nonsedating antiemetic drugs such as Zofran (ondansetron) are very effective in controlling these side effects. Low-risk patients with febrile neutropenia or deep venous thrombosis can also be treated successfully as outpatients. With these advances, almost all chemotherapy administration is now done in an outpatient setting. M. D. Anderson’s quickly growing Ambulatory Treatment Center (ATC) is now the largest outpatient infusion center in the world, with over 50,000 patient visits a year.
One-stop shopping M. D. Anderson’s outpatient services have expanded exponentially in recent years to meet the growing demand. Multidisciplinary care centers were implemented throughout the institution in the 1990s to provide patients with a convenient and comfortable setting in which to receive outpatient care. These specialized clinics, organized around specific types of cancer, provide coordinated care from many different specialties, including diagnostic imaging, medical oncology, phlebotomy, radiation oncology, surgical oncology, and supportive care specialties, allowing patients to receive all their treatments at one facility. The care centers have become the hub of patient care at M. D. Anderson and continue to grow, with over 600,000 patient visits during the past year alone. To continue to meet the growing need for high-quality outpatient care, M. D. Anderson will open a new Ambulatory Clinical Building (ACB) in March. The eight-floor, 781,000-square-foot facility will house expanded multidisciplinary care centers for breast, genitourinary, and gynecologic cancers, as well as a host of support programs. Patients in these centers will have access to most services they need under one roof. “The idea was to take a ‘one-stop shopping’ approach so patients wouldn’t have to shuttle all around our growing campus for different services,” said Janet Sisolak, facilities project director. Toward that end, the ACB features a 75-bed Ambulatory Treatment Center for chemotherapy and transfusion services, outpatient surgery, laboratory and pathology services, fine-needle aspiration, a pharmacy, and a number of other treatment support services. Diagnostic Imaging and Radiation Oncology will greatly expand in the ACB while continuing to provide services on the main campus as well. The service will be equipped with 80 pieces of diagnostic equipment, six linear accelerators (with the capacity for two more), four magnetic resonance imaging machines, six computed tomography machines, two positron emission tomography cameras, and 11 nuclear medicine machines. Filled with natural light, cheerful colors, and décor meant to soothe, the Ambulatory Clinical Building was designed with patient comfort and convenience in mind. Extensive focus groups with patients and caregivers helped architects plan a building that will provide advanced care in a relaxed environment that doesn’t feel like a hospital. The facility features a two-story water wall, bubble columns, outdoor gardens, and glass etched with nature scenes. It will also provide social services support, case managers, a chaplain, patient advocates, an international center, a patient library, a children’s play area, the Place…of wellness program, and a 200-seat food court. A climate-controlled, quarter-mile pedestrian bridge will connect the ACB to the existing outpatient clinic building, the new Cancer Prevention Building, and other campus buildings, and motorized carts will be available to speed the journey. And speeding the journey is what the Ambulatory Clinical Building is all about. The goal is to provide easy access to services in a cheerful, uplifting atmosphere in the hope of making cancer treatment less stressful so patients can focus all their energies on the most important journey: the road to recovery. For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789. Other articles in OncoLog, November 2004 issue:
 TOP
Home/Current
Issue | Previous
Issues | Articles
by Topic | Patient Education ©2008 The University of Texas M. D. Anderson Cancer Center |
|||||||||
