In 2001, the hospitals of Lagny Marne la Vallée, Bry sur Marne and Coulommiers decided to formalize their cooperation in the field of cancerology by creating a network called “ONCOVAL”. The statutes of the network, constituted in the form of an association, were deposited with the prefecture on 21 June 2001 (Annex 1): publication Journal Officiel of 14 July 2001).
The network is located in a geographical area characterized by a population that has been growing strongly in recent years, notably with the extension of the Marne la Vallée sector. Studies carried out jointly by the HRA and CRAMIF, dated February 1999, confirm this finding, since between 1990 and 2000, it is mentioned that the northern part of the Seine et Marne department, the territorial base for the development of the ONCOVAL network (cf. Annex 2), has experienced a significant increase in its population, all age groups, which is expected to continue at + 29.76%.
The predictable increase in the number of cancers linked to, among other things, the continued growth of the population implies a strong mobilization of all the medical, paramedical, public or private personnel around the improvement of the care of the patients.
The analysis of epidemiological indicators in oncology has corroborated the need to strengthen links between health professionals.
Indeed, these indicators show that in Seine and Marne:
- Life expectancy is lower than that of the Ile-de-France region and France,
- Cancers constitute the second cause of morbidity in the department,
- The finding of a significant excess mortality by tumors in the department compared to the rest of France;
- Premature mortality from cancer in the department.
It should also be noted that the overall findings from the study conducted by ARHIF and CRAMIF and according to the indicators monitored by the Hôpital de Bry sur Marne are valid for the department of Val de Marne.
The primary objective of the network is to develop cooperation between multiple actors in the management of cancer patients in a network guaranteeing the most optimal quality of care regardless of the stage of the disease.
This cross-functional network already functioning between the Bry, Coulommiers and Lagny Marne la Vallée establishments has led to a dynamic and a real quality approach, the beneficiary of which is the patient. This inter-institutional organization has made it possible to construct the foundations essential for an extension of the network in our catchment area.
Such a network should make it possible to involve general practitioners, liberal specialists, para-hospital structures and liberal caregivers in the hero instinct phrases and:
- To assist in the development of community-based and quality care
- To offer equal access to this care and in particular to the technical platform of the network
- To recognize and disseminate references in particular in the diagnosis, monitoring and implementation of chemotherapies
- To participate in national screening campaigns
The network thus constituted is in line with the objectives of SROSS by ensuring continuity and coordination of care. It also meets the guidelines set out in Circular No. 98-213 of 24 March 1998 on the organization of cancer care in public and private institutions.
ARTICLE 1: PURPOSE
The purpose of this agreement, in accordance with the provisions of Article L 6121-5 of the Public Health Code, is to describe the objectives, the means implemented and the modalities of cooperation between healthcare structures and health professionals Members of the ONCOVAL network.
ARTICLE 2: GEOGRAPHICAL DESSERT OF THE NETWORK
The population concerned is constituted by the inhabitants of the health sector 13 “Seine and Marne Nord” enlarged to the bordering communes
Beyond the above-mentioned sector, partnerships may be established with other neighboring networks.
ARTICLE 3: FIELD OF PATHOLOGY
The network covers all prevention, screening, diagnosis, treatment and follow-up activities necessary for the management of patients with malignant pathology, excluding hematologic and pediatric pathologies, subject to the means available In the reference area.
ARTICLE 4: PURPOSES OF THE NETWORK
The aim of the system and the means implemented by the ONCOVAL network is to
improve the quality of care for patients suffering from cancer, continuity of care and safety (taking into account economic constraints).
The aim is to ensure the population of the catchment area concerned:
- Quality care regardless of the stage of the illness,
- Adapted access to innovative techniques and treatments,
- Better psychological and social support.
ARTICLE 5: OBJECTIVES AND MEANS IMPLEMENTED BY THE NETWORK
5.1 FOR HEALTH PROFESSIONALS:
ONCOVAL Network aims to establish close collaboration among its participants in order to ensure that each patient, his catchment area, suffering from cancer, And continues in a multidisciplinary context guaranteeing an optimal quality of treatment according to known scientific data. To the hospitals (public or private) the network associates liberal doctors, all other health professionals and health and social organizations.
Its involvement (in regional health policy research) must take the form of actions covering the field ranging from prevention and screening to palliative care, always with a concern for quality and proximity, while distinguishing in the management of these pathologies:
- The phase of prevention and screening that is part of public health objectives,
- The phase of definition of the diagnostic and therapeutic strategies that falls under the Interdisciplinary Committees of Cancerology,
- The phase of implementation of therapeutics and follow-up, which involves, as appropriate, structures, practitioners from different specialties, general practitioners, health professionals and health and social organizations.
5.2 FOR THE PATIENT
Any patient suffering from a cancer pathology who accepts his / her care by the network will be ensured:
- Of taking into account all its medical, psychological and social dimensions,
- To be able to benefit from equal access to quality care and to the improvement of the service rendered because of the care taken by the various structures of the network,
- Facilitation of treatment at home or in the vicinity as often as is permitted by illness and optimization of care in order to maintain the familial and social connection which constitutes an important factor in the therapeutic process,
- Of follow-up by the different participants of the network by means of the development of a harmonized patient file, facilitating the therapeutic evaluation.
5.3 COMMITMENTS BY HEALTHCARE PROFESSIONALS
Institutions and Health Professionals, members of the ONCOVAL Network, undertake:
- To develop an assessment of the quality of care provided by network participants, including evaluation of the oncology care process and any accreditation procedure (see Articles 13 and 14)
- To take any medical or paramedical training likely to improve their knowledge with regard to cancer pathology and its consequences (cf. article 10);
- To set up the organization of a collegiate and multidisciplinary care of the patient,
- To ensure the continuity and coordination of care for all patients, including through the adoption of specific procedures between healthcare establishments or liberal professionals, and by collaboration between medical participants and social or medical structures -social organizations concerned with the care of the patient,
- To exchange data and information to define diagnostic and therapeutic strategies in oncology,
- To encourage a graduated organization of care, in order to optimize the use of highly specialized techniques,
5.4 UTILIZATION OF MODERN QUANTITIES FOR RAPID TRANSMISSION OF INFORMATION
The network is committed to developing an Intranet system with a secure site and network to ensure efficient and rapid transmission of patient information in compliance with the legislation relating to the patient ‘ Exchange of medical and social data, data necessary for the information of health professionals and their continuing education, data for evaluation studies (see Article 13: evaluation).
ARTICLE 6: ORGANIZATION OF THE NETWORK
6.1.1 Organization within the ONCOVAL Network
Pathology is characterized by the complexity of medical techniques, the diversity of specialists, as well as the diversity of the participants in the practice of prevention, screening, curative or palliative care. Thus, the chosen concept of the network of care in cancerology translates into an interactive system composed of all the actors involved in the care, diagnosis, treatment and support of the patient.
The network is open to any institution and health professional, legal or physical person, public or private, participating in the curative or palliative care of the cancer pathologies of the basin of attraction.
Participation in the network requires adherence to the constitutive convention of the ONCOVAL network and its charter as well as the adoption of the new organizational methods required for networking.
The founding members of the network are:
- The private hospital participating in the public service, Saint-Camille in BRY / MARNE (VAL DE MARNE)
- The LAGNY-MARNE LA VALLEE hospital (SEINE AND MARNE)
- The hospital center of COULOMMIERS (SEINE AND MARNE)
The relative seniority of the relationships between the three founding members allowed to “smoothen” the mechanisms of harmonized care of the patients within the network, still facilitated by a sharing of medical and paramedical time.
6.1.2 Membership of a professional in the network
Membership is based on voluntary service and non-exclusivity. Members may be any legal or natural person adhering to the statutes of the association and undertaking to respect the charter.
The list of professionals from public or private institutions of the liberal or associative sector belonging to the network is given in Appendix 3 to this agreement.
6.1.3 The intervention of the Interdisciplinary Committee on Cancer
Patient entry into the network implies ipso facto that its management revolves around the existence of the INTERDISCIPLINARY COMMITTEES OF CANCEROLOGY (CIC) organized within it, consisting of a necessary and sufficient quorum that can bring together practitioners Private partnerships and the public. The committees verify the value and completeness of the documents needed to make a rational decision and provide a therapeutic response and guidance.
All patients should be identified through these CICs, either for information purposes or for the implementation of a thesaurus protocol, or for discussion of treatment modalities.
This directory is as comprehensive as possible and is essential for:
- Follow-up of patients
- Verify relevance and adequacy to the thesaurus,
- Compare intra-institutional and inter-institutional practices …
Their activity requires, among other things:
- A physician facilitator of the meeting,
- A doctor “in charge” presenting the file,
- A responsible secretariat,
(See how the existing and future CICs function as Annex 4).
To date, there are:
- 1 weekly CIC at the Saint-Camille Hospital
- 1 CIC weekly at the Coulommiers hospital
- 4 CIC weekly at the hospital of Lagny: digestive, orl-Stomato-oph, Pneumology, Breast
The increase of the network, the adherence of other stakeholders will encourage and require the establishment of other CICs
The CICs will rely in their activity on:
- Harmonized protocols: THE THESAURUS (appendix 5) Networking involves observing a practice in conformity with a THESAURUS developed and accepted by all, in accordance with the various regional or national Consensus Conferences, in particular the Standard, Options And Recommendations (SOR) of the FNCLCC. This THESAURUS will be regularly updated during meetings organized for this purpose, open to all members. The dissemination of the protocols contained in the thesaurus will be made to all CICs for application and will be sent to each member of the network who so requests. In the long term, its consultation will be possible on the Internet site of the network according to modalities to be defined.
- A physician COORDINATOR The mission of this committee will be to: ü promote the setting up, operation and harmonization of the Interdisciplinary Committees of Cancerology, Thesaurus Committees … ü manage “anonymized” files from the patient files completed during the CIC with an evolution to a minimum transferable file with a unique network number. The purpose of this case management is to: – provide epidemiological data – assess the state of medical practices with cross-sectional studies – collect and inform on the main elements of patient follow-up ü provide any informative document on: – cancer management – CIC organization charts
6.1.4 Patient entry into the network
All patients with a cancer pathology, other than children and hematology, are likely to be included at some point in their network.
It is done through the doctor, adherent to the network which, on the occasion of the diagnosis of cancer pathology or its suspicion, will propose to the patient a management in the network. This entry can also be made at all stages of the disease and sometimes by a non-medical intermediary.
The members of the network undertake to make known to the patients or their legal representatives, in order to ensure perfect information and respect for the fundamental principle of free choice, their belonging to the network and to obtain their consent before any orientation within this one. A specific informative document on this mode of cooperation will be established and given to each patient or his legal representative. It will explain in particular the functioning of the structures, their complementarity and their distinct mode of operation. This will allow for the free and informed consent of the patients and / or their legal representatives.
The hospital structures undertake to include in their hospitality booklet information on the network. The other structures or speakers, not bound by the welcome booklet, will also give corresponding information, whatever their form, to their patients.
6.1.5 Patient follow-up Patient
Follow-up and continuity of care are therefore based on the need to create a city / hospital interface. It has several components:
- A functional unit comprising at least one nurse, a secretariat and a social worker is set up within the health establishment to prepare for the patient’s return home by assessing the social, medical and technical conditions and making the necessary arrangements. Treatment, chemotherapy, surveillance, radiotherapy, palliative care …
It takes contact with all the possible interveners and in particular the attending physician. If necessary a member of the Unit travels home for consultation.
- The paper notebook in paper form that is being developed for evaluation in June 2002. This is the patient’s property and it has custody of it. It is given to him when he enters the network with the consent card. In addition to administrative data, this includes:
- Information about the network
- The coordinates of:
- Physician referent Conf. glossary
- Physician (s) “in charge”
- Socio-economic data
- Medical data including the therapeutic project taking into account the psychological impact of these writings on the patient and his family.
- Leaflets enabling all the interveners as well as the patient to write their observations thus ensuring a follow-up and a continuity of care.
Ultimately, the use of computer resources will be necessary, the objective being to be able, after the use of the paper file, to communicate through the development of a common computerized minimum medical record.
6.1.6 Output of the patient
Obviously, the patient is able to leave the network at any time, regardless of his motivation. The members of the network undertake:
- On the one hand to facilitate its request by providing the patient or his family with all the necessary information (name and address of structures, specialists, etc.)
- To provide all necessary documents for this transfer of responsibility, thus avoiding any redundancy in consultations and examinations
- To take back without thought in the network the patient if its state justifies it, while being vigilant on the necessity to absolutely avoid the Medical Nomadism.
6.2 Graduation of care
For this activity centered on the patient and his / her family, the Oncoval Network will help in a notion of graduation of care:
- The active participation of all stakeholders:
- Social workers
- All care facilities: HAD, home care, etc …
- Patients and their families: League against Cancer, Patient Associations, etc …
To facilitate exchanges between all professionals who are members of the network, a directory is produced (see appendix 6). It contains information enabling the desired correspondent to be reached as easily as possible. It is essentially a working tool with no claim to exclusivity.
A paper version had been produced for the founding members. It has already been updated on the occasion of the last general meeting and will be regularly updated as the network develops. Eventually a computerized version will be produced.
- Connection with other palliative care networks
- OMEGA: This network already works for patients in the catchment area and its headquarters is at the Lagny Hospital of Cancer
- RESOMED: The ONCOVAL Network is a member of the Board of Directors of Résomed and serves on the Board as Vice President.
- Of contact with reference centers
- Institut Curie via Résomed
- Other centers according to the location and the type of cancer (breast, liver, etc.): a formalization will be carried out in the form of an agreement
ARTICLE 7: OPERATION AND MANAGEMENT OF THE NETWORK
For its operation and its management, the ONCOVAL network is based (see preamble) on an association governed by the law of 1 July 1901, known as the ONCOVAL Association.
The statutes of the association annexed to this Convention are in conformity with the content of the latter and take into account the objectives and tasks of the network (see Annex 7).
Membership in the network is subject to the acceptance of this agreement and the charter.
ARTICLE 8: THE NETWORK COORDINATION STRUCTURE
The office of the association (see composition in appendix 8) constitutes the steering body of the network. It is composed of 8 members, half of them from the founding members:
- 1 chairman and one vice-chairman
- 1 secretary and 1 assistant secretary
- 1 Treasurer and Assistant Treasurer
- 1 member
This steering body can rely, as part of its mission, on the commission of animation of the site specialized in cancerology, site founded by the hospitals of Bry sur Marne, Coulommiers and Lagny Marne la Vallée (see appendix n ° 9) .
ARTICLE 9: OBLIGATION OF NETWORK MEMBERS
The obligations of members of the network are laid down in the charter of the ONCOVAL network annexed to this Convention (Annex 10).
ARTICLE 10: TRAINING OF NETWORK MEMBERS
The training is based on:
- The realization of theoretical and practical continuing training activities on topics that will be retained by the members of the network on the basis of the existing FMCs,
- The creation of a library dedicated to oncology with easy access for the members of the network,
- The production of “good behaviors” sheets concerning various situations (implantable chamber, febrile aplasia, etc.). To this can be added the nursing thesaurus project, which should make it possible, beyond technical data sheets and processes, to seek consensus in the network for good nursing practice,
- Encouragement and facilitation of participation in cancer meetings and congresses with publication for the network of summaries concerning the most important facts,
ARTICLE 11: RESEARCH ACTIVITIES
The network aims to contribute to the scientific spirit and research in clinical trials initiated by referral centers and others.
Supervision of these activities will be the responsibility of a scientific committee.
ARTICLE 12: FINANCING THE NETWORK
12.1 THE NETWORK’S OWN RESOURCES INCLUDE:
- Entry fees, contributions and other financial contributions as well as the financial or industrial contributions paid by the members in accordance with Article 6 of the ONCOVAL status; In the event that the financing of the association is borne by only one of the founding members, the latter retains the possibility of unilaterally fixing the annual amount of its participation;
- Subsidies from the State, the departments and communes and their public establishments;
- The proceeds of services provided by the association;
- Manual donations;
- All other resources compatible with the missions and the purpose of the association.
12.2 FINANCING NEEDS OF THE NETWORK
In order to ensure the functioning of the network, funding covering the costs of medical personnel (1.50 for coordination and reinforcement of medical staff within the network) and non-medical personnel (0 , 50 medical secretary per institution: 1.50 + 0.50 medical secretary for the coordination and centralization of information and data) is necessary, the envelope corresponding to the financing of these needs may be devolved to a health institution member of the Network to the network or to the association. After evaluation of the activities of the network, funding may be modified.
In order to allow the Liberal doctors to participate effectively in the network, it is necessary to provide for the financing of vacancies. A pool of 52 vacations is therefore planned in order to enable them to participate without financial loss in the meetings of the Bureau, the General Assembly, the CICs, the training days, the days of reflection on the implementation of the mechanisms provided for in the Network such as the patient’s notebook.
In addition, for the development of computerization, priority is given to the financing of a study mission (560 000 F). The aim is to enable the network to be able to obtain the advice of a person skilled in the art. For one year, the mission will carry out, as indicated in the present Convention on the development of a ”
- To measure network activity,
- To exchange data between professionals,
- The creation of a common minimum medical record circulating,
- The dissemination of support protocols to members,
- Online access to the directory of network professionals,
- Access to professional information,
- The analysis of satisfaction surveys (of patients and professionals).
The network wishes to be able to set up:
- The exchange of computerized data concerning the activities of establishments or services in order to have a better knowledge of regional needs in terms of oncology;
- Computerized assessment: medical, medico-economic, practices, patient satisfaction and partners.
Of course, this approach is also part of a partnership with the various IMGs and in line with the recommendations of the CNIL.
In the promoter file (project saving sheet), a sheet summarizes the total estimated budget of the network (operating costs …).
ARTICLE 13: INTERNAL NETWORK EVALUATION
13.1 QUALITATIVE EVALUATION:
During the period of network upgrade (3 years), the evaluation of the network will be external. It will be carried out continuously by an expert (outside the network) paid for this purpose.
In addition, and in order to allow a regular evaluation of its functioning and impact, members of the ONCOVAL network will participate in the preparation of an annual activity report.
This will include qualitative and quantitative performance indicators that take into account the quality of care and patient satisfaction and allow analysis of the medical, economic and organizational interest of the network.
To this end, internal evaluation procedures will be implemented on a regular basis in order to highlight the strengths and weaknesses of the “chain” thus constituted and to make the necessary modifications to achieve the expected performance, in case Of the gap between the objectives and the actions carried out.
The structuring of the network is one of the first processes to be evaluated:
- The ability of the network to federate new members,
- The degree of mobilization of participants,
- The relevance of its composition,
- The relevance of the objectives.
Then several types of processes will have to be evaluated:
- Patient satisfaction based on surveys of the patient, family and physicians on a regular basis,
- The needs and satisfaction of network professionals,
- The impact of thesauri on clinical practice: random draw and analysis of 10 patient records by CIC once a year to measure network effectiveness. This regular assessment will allow to describe the observed changes, the variations between the institutions and to study the explanatory factors for these variations. It will rely in particular on a clinical audit methodology in “before-after” and then “here-elsewhere” surveys.
13.2 ECONOMIC EVALUATION:
In relation to the economic aspect, in co-operation with the sickness insurance funds, the evaluation will include the cost of taking care of cancer pathology within the network and off-grid.
The coordination of the various actors, the adherence to a common methodology, the elaboration of common protocols, a common evaluation, the setting up of specific training courses … must rationalize the running costs. The availability of field teams, of a common logistics must also allow a more economical use of the means placed at our disposal.
ARTICLE 14: ACCREDITATION
The members of the network undertake to apply for accreditation of the network in accordance with the procedure laid down in Article L 6 113.4 of the Public Health Code.
ARTICLE 15: APPROVAL
This agreement is subject, in accordance with the last paragraph of Article L 6 121.5 of the Public Health Code, to the approval of the Director of the ARH d’Ile de France.
It shall become enforceable upon receipt by the signatory institutions of the aforesaid authorization.
The Bureau shall be responsible for the execution of this Convention.
ARTICLE 16: DURATION OF THE CONVENTION
This Agreement is established for a period of five years. It is renewable by tacit agreement for the same duration. Its modifications are the responsibility of the office of the association of the network after validation by the general assembly and by way of endorsement which will be subject to the approval of the ARH Ile de France. It may be denounced with six months’ notice by the signatories of the network by mail with acknowledgment of receipt sent to the registered office of the ONCOVAL network.
The efficient and harmonious operation of the ONCOVAL Network is based on the following two decisive principles:
- The size of the network must allow for a collegial decision for optimal care of the patient; The network acts as a simple, non-centralized structure where the opinion of each actor is taken into account.
- The role of the general practitioner and the liberal nurse is emphasized because of their involvement with the hospital service. Their knowledge of the patient, his surroundings and his surroundings are paramount, as is the quality of follow-up and support at home.
Done at Lagny on 15 February 2001
The members of the Bureau:
The President, Dr VAN DEN AKKER
The Vice-President, Dr LEBEGUE
The Secretary, Miss CAMUS
The Deputy Secretary, Dr BLASKA-JAULERRY
The Treasurer, Mrs BRUNET
Assistant Treasurer Mr NAMAN
Member of the Board, Dr GATFOSSE
The member of the Bureau, Mr VERRIEZ