Off the coast of North Carolina, the barrier islands鈥攃alled the Outer Banks鈥攐ften draw tourists who flock to the area鈥檚 stretches of beaches in the warmer summer months. But when the beach crowds subside, the community remains home to an aging population of about 40,000 residents who need quality health care services year-round.
When , a 19-bed hospital in the beach town of Nags Head, North Carolina, first opened in 2002, the hospital鈥檚 goal was to provide comprehensive immediate care to the area鈥檚 aging population. But early on, hospital staff noticed that when diagnosed with cancer, residents often had to leave Nags Head, making a several-hour round trip to Norfolk, Virginia, or other larger cities, often many times a month during their cancer treatment.
鈥淲e realized very early that cancer was a growing issue on the island,鈥� said Charles Shelton, MD, medical director of Outer Banks Health and a member of the Commission on Cancer (CoC) Quality Improvement Committee. 鈥淓ven though there were some cancer services on the island, they were very sporadic and poorly coordinated. Patients would get what they could on the island, but most of the time, they would still leave the area to get some component of their care.鈥�
By hospital estimates, in the first 5 years of its opening, Outer Banks Health staff interacted with less than 10% of local cancer patients, suggesting that the vast majority of patients in the area had to leave the county to receive cancer treatment.
A Manual for Survival
Looking to improve cancer care at their hospital, Dr. Shelton and his team sought accreditation from the CoC. CoC accreditation ensures hospitals meet a core set of more than 34 broad standards that help improve the quality of care through evidence-based cancer-related programs and activities. These programs are concerned with the full continuum of cancer care鈥攆rom prevention to survivorship and end-of-life care鈥攚hile addressing both survival and quality of life.
Approximately 1,400 hospitals and cancer centers are CoC-accredited in the U.S. About a quarter of these hospitals are accredited as community cancer programs, which means that they treat fewer than 500 newly diagnosed cancer cases per year.
After applying for accreditation in 2015 and having a successful site visit, Outer Banks Health received CoC accreditation in 2016 and gained accreditation from the National Accreditation Program for Breast Centers (NAPBC) in 2022.
Dr. Shelton said that while receiving accreditation can initially seem like a daunting process for smaller hospitals, receiving accreditation was feasible and has offered considerable long-term benefits.
鈥淭he CoC manual is really a survival manual,鈥� he said. 鈥淚t allows us to address all aspects of the needed components of proactive cancer care, from screening to prevention. For us, that鈥檚 been a huge part of addressing and developing a process for cancer care in Nags Head.鈥�
Dr. Shelton shares three lessons learned from his hospital鈥檚 journey to achieving CoC and NAPBC accreditation.
Lessons Learned from CoC and NAPBC Accreditation
Leverage Partnerships to Strengthen Existing Resources
CoC accreditation requires cancer care to be treated through a multidisciplinary lens, which includes input not only from surgeons but also from radiologists, pathologists, radiation oncologists, and medical oncologists. At the start of its accreditation process, Outer Banks Health sought to leverage partnerships with nearby hospitals that had a larger pool of resources. They hired a director of cancer services and developed an oncology navigation program鈥攚hich helps patients through decision-making and treatment options鈥攖hrough a partnership with the University of North Carolina. They also have ongoing partnerships with ECU Health in North Carolina and Chesapeake General Hospital in Virginia, both of which are CoC-accredited. Leveraging these community partnerships enabled a smaller hospital like Outer Banks Health to glean from the expertise of a broad group of experts who can advise on treatment strategies and review patient cases together, Dr. Shelton said.
Quality Care Drives Patient Volumes
CoC accreditation requires that hospitals invest in the cancer services they can provide patients on-site or by referral, including diagnostic imaging and radiation oncology. Since receiving CoC accreditation, the hospital has seen a steady increase in the number of patients seeking cancer care at Outer Banks Health. The hospital is now involved with more than 70% of all cancer cases in the community in some capacity, including some from neighboring counties. Additionally, 80% of breast cancers are now diagnosed at stage 0/1 at Outer Banks Health, reflecting efforts to substantially increase the number of screening mammograms on-site.
鈥淧eople want to go where they know the care is good,鈥� Dr. Shelton said. 鈥淭hey know that not only you鈥檙e providing the care, but you鈥檙e providing a high level of care because you鈥檙e following standards that hold you accountable.鈥�
The increase in patient volumes has also translated into more revenue, with the hospital investing in an $18 million cancer center that opened in 2024 to support cancer patients.
鈥淲e added and fine-tuned our services to support our growing volumes. Over time, that鈥檚 allowed us to have a greater impact on our population locally,鈥� Dr. Shelton said. 鈥淎s our volumes started to increase, we also started to think about facilities to support the growing number of patients we treat.鈥�
Accreditation Provided a Framework for Keeping Cancer Care Closer to Home
In cancer care, time is of the essence. Delays in screening, diagnoses, and treatment can all contribute to cancer gaps in rural areas. Outer Banks Health previously reported a mortality rate that was about 15% higher than the state鈥檚 baseline average; that number has decreased in the past 10 years so that the rural area now matches the state鈥檚 average鈥攕omething Dr. Shelton attributes to a streamlined process to treating cancer aided by CoC accreditation.
鈥淚t鈥檚 rare in today鈥檚 world where a patient is one and done with cancer. Usually, cancer treatment may involve surgery plus something else like hormone therapy, chemotherapy, or possibly immunotherapy,鈥� Dr. Shelton said. Although a percentage of patients still need to leave the area for some component of cancer care, such as seeing a surgical specialist, the hospital is now able to navigate this transition and support the patient with other complementary services, such as chemotherapy or radiation. These visits are often time-consuming and may need to occur frequently, so being able to do these visits closer to home can be of tremendous benefit to patients, Dr. Shelton added.
鈥淲hen you provide access to critical parts of cancer care, such as chemotherapy or radiotherapy, even if some parts may require travel, that access helps reduce disparities,鈥� Dr. Shelton said.
Participating in the NAPBC quality improvement project, Patient Reported Observations on Medical Timeliness for Breast Patients (PROMPT), also helped the hospital understand delays to care and develop processes for supporting patients with services closer to home.
Dr. Shelton noted that historically, Outer Banks Health had patients with stage 4 cancer visit the emergency room because they hadn鈥檛 received treatment before and, as a result, were likely facing only palliative care as an option. 鈥淣ow we can possibly change the prognosis for these patients, and we can potentially change their outcomes dramatically,鈥� he said. 鈥淚t鈥檚 just a win-win for your community.鈥�
鈥淢y advice to small programs is that you鈥檙e never too small to consider receiving accreditation,鈥� Dr. Shelton added. 鈥淚f you treat any number of patients, you are a candidate for accreditation as long as you follow the standards. I would recommend that any program, no matter their size or geography, would benefit from this process.鈥�
Learn more about CoC accreditation and NAPBC accreditation.
