scholarly journals Cancer Care Delivery Research: Building the Evidence Base to Support Practice Change in Community Oncology

2015 ◽  
Vol 33 (24) ◽  
pp. 2705-2711 ◽  
Author(s):  
Erin E. Kent ◽  
Sandra A. Mitchell ◽  
Kathleen M. Castro ◽  
Darren A. DeWalt ◽  
Arnold D. Kaluzny ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Care Delivery ◽  
Well Being ◽  
Evidence Base ◽  
Care Quality ◽  
Practice Change ◽  
Health Technologies ◽  
Oncology Research ◽  
Community Oncology

Understanding how health care system structures, processes, and available resources facilitate and/or hinder the delivery of quality cancer care is imperative, especially given the rapidly changing health care landscape. The emerging field of cancer care delivery research (CCDR) focuses on how organizational structures and processes, care delivery models, financing and reimbursement, health technologies, and health care provider and patient knowledge, attitudes, and behaviors influence cancer care quality, cost, and access and ultimately the health outcomes and well-being of patients and survivors. In this article, we describe attributes of CCDR, present examples of studies that illustrate those attributes, and discuss the potential impact of CCDR in addressing disparities in care. We conclude by emphasizing the need for collaborative research that links academic and community-based settings and serves simultaneously to accelerate the translation of CCDR results into practice. The National Cancer Institute recently launched its Community Oncology Research Program, which includes a focus on this area of research.

scholarly journals Evolution of Cancer Care Delivery Research in the NCI Community Oncology Research Program

2019 ◽  
Vol 112 (6) ◽  
pp. 557-561 ◽  
Author(s):  
Ann M Geiger ◽  
Ann M O’Mara ◽  
Worta J McCaskill-Stevens ◽  
Brenda Adjei ◽  
Priyanga Tuovenin ◽  
...  
Keyword(s):  
Research Program ◽  
National Cancer Institute ◽  
Cancer Care ◽  
Care Delivery ◽  
Well Being ◽  
Practice Change ◽  
Evidence Based ◽  
Oncology Research ◽  
Community Oncology ◽  
Robust Portfolio

Abstract Research seeking to improve patient engagement with decision-making, use of evidence-based guidelines, and coordination of multi-specialty care has made important contributions to the decades-long effort to improve cancer care. The National Cancer Institute expanded support for these efforts by including cancer care delivery research in the 2014 formation of the National Cancer Institute Community Oncology Research Program (NCORP). Cancer care delivery research is a multi-disciplinary effort to generate evidence-based practice change that improves clinical outcomes and patient well-being. NCORP scientists and community-based clinicians and organizations rapidly embraced the addition of this type of research into the network, resulting in a robust portfolio of observational studies and intervention studies within the first 5 years of funding. This commentary describes the initial considerations in conducting this type of research in a network previously focused on cancer prevention, control, and treatment studies; characterizes the protocols developed to date; and outlines future directions for cancer care delivery research in the second round of NCORP funding.

scholarly journals Delivering primary health care as envisioned

2018 ◽  
Vol 26 (3) ◽  
pp. 231-241 ◽  
Author(s):  
Jennifer Rayner ◽  
Laura Muldoon ◽  
Imaan Bayoumi ◽  
Dale McMurchy ◽  
Kate Mulligan ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Equity ◽  
Care Delivery ◽  
Well Being ◽  
Evidence Base ◽  
Content Type ◽  
Primary Health ◽  
Comprehensive Primary Health Care ◽  
Health And Well Being

PurposeFor over 40 years, Canadian and international bodies have endorsed comprehensive primary health care (PHC), yet very little work has been done to describe how services and programs are delivered within these organizations. Because health equity is now of greater interest to policy makers and the public, it is important to describe an evidence-informed framework for the delivery of integrated and equitable PHC. The purpose of this paper is to describe the development of a “Model of Health and Well-being” (MHWB) that provides a roadmap to the delivery of PHC in a successful network of community-governed PHC organizations in Ontario, Canada.Design/methodology/approachThe MHWB was developed through an iterative process that involved members of community-governed PHC organizations in Ontario and key stakeholders. This included literature review and consultation to ensure that the model was evidence informed and reflected actual practice.FindingsThe MHWB has three guiding principles: highest quality health and well-being for people and communities; health equity and social justice; and community vitality and belonging. In addition, there are eight attributes that describe how services are provided. There is a reasonable evidence base underpinning the all principles and attributes.Originality/valueAs comprehensive, equitable PHC organizations become increasingly recognized as critical parts of the health care system, it is important to have a means to describe their approach to care and the values that drive their care. The MHWB provides a blueprint for comprehensive PHC as delivered by over 100 Community Governed Primary Health Care (CGPHC) organizations in Ontario. All CGPHC organizations have endorsed, adopted and operationalized this model as a guide for optimum care delivery.

scholarly journals De-Implementing Ineffective and Low-value Clinical Practices: Research and Practice Opportunities in Community Oncology Settings

2021 ◽  
Author(s):  
Wynne E Norton ◽  
Worta McCaskill-Stevens ◽  
David A Chambers ◽  
Philip J Stella ◽  
Otis W Brawley ◽  
...  
Keyword(s):  
Cancer Care ◽  
Care Delivery ◽  
Implementation Strategies ◽  
Clinical Practices ◽  
National Network ◽  
Oncology Research ◽  
Community Oncology ◽  
Practice Opportunities ◽  
Oncology Care ◽  
Study Designs

Abstract Patients, practitioners, and policymakers are increasingly concerned about the delivery of ineffective or low-value clinical practices in cancer care settings. Research is needed on how to effectively de-implement these types of practices from cancer care. In this commentary, we spotlight the National Cancer Institute (NCI) Community Oncology Research Program (NCORP), a national network of community oncology practices, and elaborate on how it is an ideal infrastructure for conducting rigorous, real-world research on de-implementation. We describe key, multi-level issues that affect de-implementation and also serve as a guidepost for developing strategies to drive de-implementation. We describe optimal study designs for testing de-implementation strategies and elaborate on how and why the NCORP network is uniquely positioned to conduct rigorous and impactful de-implementation trials. The number and diversity of affiliated community oncology care sites, coupled with the overall objective of improving cancer care delivery, make the NCORP an opportune infrastructure for advancing de-implementation research while simultaneously improving the care of millions of cancer patients nationwide.

The NCI Community Oncology Research Program: What Every Clinician Needs to Know

2013 ◽  
pp. e84-e89 ◽  
Author(s):  
Worta McCaskill-Stevens ◽  
Alan P. Lyss ◽  
Marge Good ◽  
Thomas Marsland ◽  
Rogerio Lilenbaum
Keyword(s):  
Clinical Research ◽  
Clinical Oncology ◽  
Research Program ◽  
Cancer Care ◽  
Care Delivery ◽  
Community Setting ◽  
Cancer Control ◽  
Community Clinical Oncology Program ◽  
Oncology Research ◽  
Community Oncology

Research in the community setting is essential for the translation of advances in cancer research into practice and improving cancer care for all populations. The National Cancer Institute is proposing a new community-based program, NCI Community Oncology Research Program (NCORP), which is the alignment of two existing programs, the Community Clinical Oncology Program, Minority-Based Community Clinical Oncology Program, and their Research Bases, and the National Cancer Institute's Community Cancer Centers Program. NCROP will support cancer control, prevention, treatment, and screening clinical trials and expand its research scope to include cancer care delivery research. Cancer disparities research will be integrated into studies across the continuum of NCORP research. Input from current NCI-funded community investigators provides critical insight into the challenges faced by oncology practices within various organizational structures. Furthermore, these investigators identify the resources, both administrative and clinical, that will be required in the community setting to support cancer care delivery research and to meet the requirements for a new generation of clinical research. The American Society for Clinical Oncology (ASCO) has initiated a forum to focus on the conduct of clinical research in the community setting. Resources are being developed to help practices in managing cancer care in community settings.

Direct Primary Care: A Successful Financial Model for the Clinical Practice of Lifestyle Medicine

2021 ◽  
pp. 155982762110066
Author(s):  
Amy R. Mechley
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Well Being ◽  
The United States ◽  
Fee For Service ◽  
Financial Model ◽  
Lifestyle Medicine ◽  
Direct Primary

Primary care has been shown to significantly decrease the overall cost of a population’s health care while improving the quality of each person’s well-being. Lifestyle medicine (LM) is ideally positioned to be delivered via primary care and has been shown to improve short- and long-term health outcomes of patients and populations. Direct primary care (DPC) represents a viable alternative to the fee-for-service reimbursement model. It has been shown to be economically and financially sustainable. Furthermore, it has the potential to fulfill the Quadruple Aim of health care in the United States. LM practiced in a DPC model has the potential to transform health care delivery. This article will discuss the need for health care systems change, provide an overview of the DPC model, demonstrate a basic understanding of the benefits, and review the steps needed to de-risk the investment of time, money, and resources for our future DPC providers.

Prevalence and Workplace Drivers of Burnout in Cancer Care Physicians in Ontario, Canada

2021 ◽  
pp. OP.21.00170
Author(s):  
Simron Singh ◽  
Ashley Farrelly ◽  
Catherine Chan ◽  
Brett Nicholls ◽  
Narges Nazeri-Rad ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Care ◽  
Gynecologic Oncology ◽  
Maslach Burnout Inventory ◽  
Well Being ◽  
System Level ◽  
Survey Study ◽  
Cross Sectional Survey ◽  
Questionnaire Response ◽  
Mental Health Patient

PURPOSE: Provider well-being has become the fourth pillar of the quadruple aim for providing quality care. Exacerbated by the global COVID-19 pandemic, provider well-being has become a critical issue for health care systems worldwide. We describe the prevalence and key system-level drivers of burnout in oncologists in Ontario, Canada. METHODS: This is a cross-sectional survey study conducted in November-December 2019 of practicing cancer care physicians (surgical, medical, radiation, gynecologic oncology, and hematology) in Ontario, Canada. Ontario is Canada's largest province (with a population of 14.5 million), and has a single-payer publicly funded cancer system. The primary outcome was burnout experience assessed through the Maslach Burnout Inventory. RESULTS: A total of 418 physicians completed the questionnaire (response rate was 44% among confirmed oncologists). Seventy-three percent (n = 264 of 362) of oncologists had symptoms of burnout (high emotional exhaustion and/or depersonalization scores). Significant drivers of burnout identified in multivariable regression modeling included working in a hectic or chaotic atmosphere (odds ratio [OR] = 15.5; 95% CI, 3.4 to 71.5; P < .001), feeling unappreciated on the job (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), reporting poor or marginal control over workload (OR = 7.9; 95% CI, 2.9 to 21.3; P < .001), and not being comfortable talking to peers about workplace stress (OR = 3.0; 95% CI, 1.1 to 7.9; P < .001). Older age (≥ 56 years) was associated with lower odds of burnout (OR = 0.16; 95% CI, 0.1 to 0.4; P < .001). CONCLUSION: Nearly three quarters of participants met predefined standardized criteria for burnout. This number is striking, given the known impact of burnout on provider mental health, patient safety, and quality of care, and suggests Oncologists in Ontario may be a vulnerable group that warrants attention. Health care changes being driven by the COVID-19 pandemic provide an opportunity to rebuild new systems that address drivers of burnout. Creating richer peer-to-peer and leadership engagement opportunities among early- to mid-career individuals may be a worthwhile organizational strategy.

scholarly journals Komunitas Masyarakat Dan Perawatan Kesehatan Dalam Peningkatan Kualitas Hidup

2020 ◽  
Vol 10 (1) ◽  
pp. 11-24
Author(s):  
Agustinus Hermino
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health Care Quality ◽  
Health Sector ◽  
Well Being ◽  
Individual Variability ◽  
Care Quality ◽  
Global Era ◽  
The Impact

Latar belakang: Seiring dengan perkembangan jaman, dalam beberapa tahun terakhir ini banyak perhatian yang difokuskan pada eksplorasi dampak penyakit fisik dan mental pada kualitas hidup seseorang baik secara individu maupun masyarakat secara keseluruhan. Sifat subyektif dari 'kualitas hidup' individu, merupakan konsep yang dinamis untuk diukur dan didefinisikan, tetapi bahwa secara umum dapat dipandang sebagai konsep multidimensi yang menekankan pada persepsi diri dari keadaan pikiran seseorang saat iniTujuan: penulisan ini bertujuan untuk memberikan pemahaman tentang peran masyarakat dalam memahani pentingnya kesehatan di era global ditinjau dari perspektif akademis. Pada sektor kesehatan pemahaman kesehatan menjadi sangat pentingnya karena akan menunjukkan pada kualitas hidup seseorang, tetapi hal ini tidak cukup secara individu karena diperlukan pemahaman secara menyeluruh terhadap masyarakat tentang makna kesehatan dan perawatan kesehatan.Metode: penulisan ilmiah ini adalah dengan melakukan analisa akademis dari dari berbagai sumber rujukan relevan sehingga menemukan makna teoritis baru dalam rangka menjawab tantangan yang terjadi di masyarakat.Hasil: Berdasarkan berbagai sumber rujukan yang ada, dapat disimpulkan bahwa kesehatan merupakan gaya hidup yang bertujuan untuk mencapai kesejahteraan fisik, emosional, intelektual, spiritual, dan lingkungan. Penggunaan langkah-langkah kesehatan dapat meningkatkan stamina, energi, dan harga diri, kemudian meningkatkan kualitas hidup. Dengan demikian maka konsep kesehatan memungkinkan adanya variabilitas individu. Kesehatan dapat dianggap sebagai keseimbangan aspek fisik, emosional, psikologis, sosial dan spiritual dari kehidupan seseorang. Kata kunci: masyarakat, perawatan kesehatan, kualitas hidup Society Community and Health Care in Improving Quality of LifeAbstract Background: Along with the development of the era, in recent years there has been a lot of attention focused on exploring the impact of physical and mental illness on the quality of life of a person both individually and as a whole. The subjective nature of an individual's 'quality of life' is a dynamic concept to measure and define, but that in general can be seen as a multidimensional concept that emphasizes self-perception of one's current state of mindAim: purpose of this study is to provide an understanding the role of community in understanding the importance of health in the global era from an academic perspective. In the health sector understanding of health is very important because it will show the quality of life of a person, but this is not enough individually because a comprehensive understanding of the meaning of health and health care is needed. Method: The method of scientific writing is to carry out academic analysis from various relevant reference sources, and find new theoretical meanings in order to answer the challenges that occur in society. Keyword: Community, Society,Health Care, Quality oflife Resullt : Based on various academic reference, it can be concluded that health is a lifestyle that aims to achieve physical, emotional, intellectual, spiritual, and environmental well-being. The use of health measures can increase stamina, energy, and self-esteem, then improve the quality of life. Thus the concept of health allows for individual variability. Health can be considered as a balance of physical, emotional, psychological, social and spiritual aspects of one's life. Keywords: community, health care, quality of life 

Managed care Medicaid

2017 ◽  
Vol 11 (2) ◽  
pp. 198-210 ◽  
Author(s):  
William Trombetta
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Care Quality ◽  
Market Segment ◽  
Economic Aspects ◽  
Content Type ◽  
The Poor

Purpose Providing health care to the poor is evolving in the new US marketplace. The Affordable Care Act has set goals enhancing access to health care, lowering costs and improving patient outcomes. A key segment in this evolution is the most vulnerable health-care population of all: Medicaid. This paper aims to provide a general review of how providing health care to Medicaid patients is changing including how socio-economic aspects of this vulnerable population affects the quality of the health care provided. Design/methodology/approach The paper is entirely secondary research; no primary research has been conducted. Findings Managed care Medicaid provides a risk-based model to treating a vulnerable health-care market segment. The jury is still out on whether managed care Medicaid (MCM) is improving health-care quality and saving cost, but the provision of health care to the Medicaid segment is definitely shifting from a fee-for-service model to value based payment. Very recent developments of new health-care delivery approaches present a positive outlook for improving quality and containing costs going forward. Research limitations/implications At this stage, whether or not MCM saves money or provides better health-care quality to this vulnerable population is a work in progress. Health-care marketing can impact socio-economic aspects of health care for the poor. There is a need to follow up on the positive results being documented in demonstration health-care delivery models. Practical implications At this point, there has been no long-term study of whether managed care Medicaid offers better quality of health care and cost savings. The research to date suggest that the quality of health-care delivery to the poor is improving at a lower cost to payers. Social implications Medicaid patients are an underserved market segment. Managed care Medicaid offers a new model that has the potential to provide quality care at acceptable cost. Critical to this vulnerable market segment is the need to integrate socio-economic aspects of the population with the delivery of health care. Originality/value There has been very little discussion of Medicaid overall in the marketing literature, much less any discussion of managed care Medicaid.

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