Care coordination for complex cancer survivors in an integrated safety-net system: a study protocol
Abstract Background The growing numbers of cancer survivors challenge delivery of high-quality survivorship care by healthcare systems. Innovative ways to improve care coordination for patients with cancer and multiple chronic conditions (“complex cancer survivors”) are needed to achieve better care...
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doaj-16749c208d3445708dc541e82008f1b62020-11-25T00:53:56ZengBMCBMC Cancer1471-24072018-12-0118111010.1186/s12885-018-5118-7Care coordination for complex cancer survivors in an integrated safety-net system: a study protocolSimon J. Craddock Lee0Katelyn K. Jetelina1Emily Marks2Eric Shaw3Kevin Oeffinger4Deborah Cohen5Noel O. Santini6John V. Cox7Bijal A. Balasubramanian8Department of Clinical Sciences, University of Texas Southwestern Medical CenterDepartment of Epidemiology, University of Texas Health Science Center, School of Public HealthDepartment of Clinical Sciences, University of Texas Southwestern Medical CenterDepartment of Community Medicine, Mercer UniversityDepartment of Medicine, Division of Medical Oncology, Duke Cancer Institute and Duke University Medical CenterDepartment of Family Medicine, Oregon Health and Science CenterParkland Health and Hospital SystemDepartment of Clinical Sciences, University of Texas Southwestern Medical CenterHarold C. Simmons Comprehensive Cancer CenterAbstract Background The growing numbers of cancer survivors challenge delivery of high-quality survivorship care by healthcare systems. Innovative ways to improve care coordination for patients with cancer and multiple chronic conditions (“complex cancer survivors”) are needed to achieve better care outcomes, improve patient experience of care, and lower cost. Our study, Project CONNECT, will adapt and implement three evidence-based care coordination strategies, shown to be effective for primary care conditions, among complex cancer survivors. Specifically, the purpose of this study is to: 1) Implement a system-level EHR-driven intervention for 500 complex cancer survivors at Parkland; 2) Test effectiveness of the strategies on system- and patient-level outcomes measured before and after implementation; and 3) Elucidate system and patient factors that facilitate or hinder implementation and result in differences in experiences of care coordination between complex patients with and without cancer. Methods Project CONNECT is a quasi-experimental implementation study among 500 breast and colorectal cancer survivors with at least one of the following chronic conditions: diabetes, hypertension, chronic lung disease, chronic kidney disease, or heart disease. We will implement three evidence-based care coordination strategies in a large, county integrated safety-net health system: 1) an EHR-driven registry to facilitate patient transitions between primary and oncology care; 2) co-locating a nurse practitioner trained in care coordination within a complex care team; 3) and enhancing teamwork through coaching. Segmented regression analysis will evaluate change in system-level (i.e. composite care quality score) and patient-level outcomes (i.e. self-reported care coordination). To evaluate implementation, we will merge quantitative findings with structured observations and physician and patient interviews. Discussion This study will result in an evaluation toolkit identifying key model elements, barriers, and facilitators that can be used to guide care coordination interventions in other safety-net settings. Because Parkland is a vanguard of safety-net healthcare nationally, findings will be widely applicable as other safety-nets move toward increased integration, enhanced EHR capability, and experience with growing patient diversity. Our proposal recognizes the complexity of interventions and scaffolds evidence-based strategies together to meet the needs of complex patients, systems of care, and service integration. Trial registration ClinicalTrials.gov, NCT02943265. Registered 24 October 2016.http://link.springer.com/article/10.1186/s12885-018-5118-7Care coordinationCancer survivorship carePrimary careOncology |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Simon J. Craddock Lee Katelyn K. Jetelina Emily Marks Eric Shaw Kevin Oeffinger Deborah Cohen Noel O. Santini John V. Cox Bijal A. Balasubramanian |
spellingShingle |
Simon J. Craddock Lee Katelyn K. Jetelina Emily Marks Eric Shaw Kevin Oeffinger Deborah Cohen Noel O. Santini John V. Cox Bijal A. Balasubramanian Care coordination for complex cancer survivors in an integrated safety-net system: a study protocol BMC Cancer Care coordination Cancer survivorship care Primary care Oncology |
author_facet |
Simon J. Craddock Lee Katelyn K. Jetelina Emily Marks Eric Shaw Kevin Oeffinger Deborah Cohen Noel O. Santini John V. Cox Bijal A. Balasubramanian |
author_sort |
Simon J. Craddock Lee |
title |
Care coordination for complex cancer survivors in an integrated safety-net system: a study protocol |
title_short |
Care coordination for complex cancer survivors in an integrated safety-net system: a study protocol |
title_full |
Care coordination for complex cancer survivors in an integrated safety-net system: a study protocol |
title_fullStr |
Care coordination for complex cancer survivors in an integrated safety-net system: a study protocol |
title_full_unstemmed |
Care coordination for complex cancer survivors in an integrated safety-net system: a study protocol |
title_sort |
care coordination for complex cancer survivors in an integrated safety-net system: a study protocol |
publisher |
BMC |
series |
BMC Cancer |
issn |
1471-2407 |
publishDate |
2018-12-01 |
description |
Abstract Background The growing numbers of cancer survivors challenge delivery of high-quality survivorship care by healthcare systems. Innovative ways to improve care coordination for patients with cancer and multiple chronic conditions (“complex cancer survivors”) are needed to achieve better care outcomes, improve patient experience of care, and lower cost. Our study, Project CONNECT, will adapt and implement three evidence-based care coordination strategies, shown to be effective for primary care conditions, among complex cancer survivors. Specifically, the purpose of this study is to: 1) Implement a system-level EHR-driven intervention for 500 complex cancer survivors at Parkland; 2) Test effectiveness of the strategies on system- and patient-level outcomes measured before and after implementation; and 3) Elucidate system and patient factors that facilitate or hinder implementation and result in differences in experiences of care coordination between complex patients with and without cancer. Methods Project CONNECT is a quasi-experimental implementation study among 500 breast and colorectal cancer survivors with at least one of the following chronic conditions: diabetes, hypertension, chronic lung disease, chronic kidney disease, or heart disease. We will implement three evidence-based care coordination strategies in a large, county integrated safety-net health system: 1) an EHR-driven registry to facilitate patient transitions between primary and oncology care; 2) co-locating a nurse practitioner trained in care coordination within a complex care team; 3) and enhancing teamwork through coaching. Segmented regression analysis will evaluate change in system-level (i.e. composite care quality score) and patient-level outcomes (i.e. self-reported care coordination). To evaluate implementation, we will merge quantitative findings with structured observations and physician and patient interviews. Discussion This study will result in an evaluation toolkit identifying key model elements, barriers, and facilitators that can be used to guide care coordination interventions in other safety-net settings. Because Parkland is a vanguard of safety-net healthcare nationally, findings will be widely applicable as other safety-nets move toward increased integration, enhanced EHR capability, and experience with growing patient diversity. Our proposal recognizes the complexity of interventions and scaffolds evidence-based strategies together to meet the needs of complex patients, systems of care, and service integration. Trial registration ClinicalTrials.gov, NCT02943265. Registered 24 October 2016. |
topic |
Care coordination Cancer survivorship care Primary care Oncology |
url |
http://link.springer.com/article/10.1186/s12885-018-5118-7 |
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