Developing and evaluating new models of care in hematology.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 53-53
Author(s):  
Tom Kouroukis ◽  
Jenna Ratcliffe ◽  
Karen Running ◽  
Jonathan Sussman
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Cancer Care ◽  
Models Of Care ◽  
Care Plan ◽  
Care Plans ◽  
Edmonton Symptom Assessment Scale ◽  
New Models ◽  
Care Models

53 Background: The duration of care for patients with hematological malignancies (HM) from diagnosis to discharge can often be five years or longer, during which patients frequently visit their hematologist but may not maintain contact with their primary care physician (PCP). This can result in gaps in the care of non cancer health problems. A number of studies in solid tumors have highlighted the benefits of maintaining contact with the PCP however there has been little published on survivorship care in HM. Objective. Develop and evaluate models of care in hematology that facilitate transition to the PCP where appropriate. Methods: This study used a stepwise approach to inform the development and evaluation of care models. Models were developed using: a literature review; expert opinion; input from patient and PCP focus groups. The survivorship model (SM) was evaluated in a longitudinal, cohort of patients using validated patient surveys: Coordination of Cancer Care Questionnaire; Edmonton Symptom Assessment Scale; EQ5D-QoL. Results: Focus groups were conducted with 26 participants. Patients indicated they would be willing to engage with their PCP if primary care were more confident in their cancer care abilities, and if communication improved between specialty and PCP. PCPs felt care plans should be clear, concise and within their scope. Three new models of care were developed based on level of care need (survivorship, shared, engagement). The SM has been tested with 50 patients who have completed treatment and follow up. Survey results indicated the majority of SM patients: continued to feel well; reported high functioning; had seen their PCP since discharge; were satisfied with the coordination of their care. Fifteen PCPs responded to a follow up survey. PCPs were: satisfied with the SM care plan and aware of the repatriation process to specialty care, if needed. Conclusions: Patient involvement in model design was instrumental in the success of the project. PCPs reported that the tools developed in this pilot enhanced the care experience and provider collaboration. These findings warrant further testing of care models in a comparative study with this complex cancer population.

scholarly journals Advanced practice nurses, registered nurses and medical practice assistants in new care models in Swiss primary care: a focused ethnography of their professional roles

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033929
Author(s):  
Renata Josi ◽  
Monica Bianchi
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Chronic Care ◽  
Advanced Practice Nurses ◽  
Models Of Care ◽  
Advanced Practice ◽  
Practice Nurses ◽  
New Models ◽  
Care Models ◽  
Swiss Primary Care

ObjectivesWe aimed to analyse roles and tasks of advanced practice nurses (APNs), registered nurses (RNs) without advanced practice education and medical practice assistants (MPAs) with regard to chronic care in Swiss primary care (PC). The objective of this study was to explore the potential of new care models, involving these health professionals, which could meet changing future healthcare needs.DesignAn ethnographic design comprising semi-structured interviews and non-participant observations was conducted.SettingHealth professionals who worked in 10 primary care practices in the German-speaking part of Switzerland were included in the study.ParticipantsIn total, 16 interviews were conducted with four APNs, six MPAs, two RNs and four general practitioners (GPs). Nine of the health professionals were subsequently observed in their primary care practice.ResultsAPNs and MPAs were both involved in chronic care in the PC practice. While APNs cared for older, multimorbid patients with more complex needs, MPAs were involved in counselling of younger patients with chronic disease such as type 2 diabetes. Additionally, APNs were involved in many home visits and visits in elderly peoples — and nursing homes. APNs worked with a high degree of autonomy while MPAs had worked mostly in delegation. Task division between GPs and APNs or MPAs was not clear in every case yet.ConclusionsAPNs and MPAs have a high potential to contribute to optimal care in new care models, which address needs of the elderly population. The experience from our sample may inform international health policymakers and practitioners about the tasks and responsibilities those health professionals can take over in PC when implementing new models of care. The practical experience with new models of care involving APNs and MPAs may also influence the future regulation with regard to the scope of practice of these health professionals in Switzerland.

scholarly journals Development of an interactive, web-based shared care plan to facilitate the follow-up care of colorectal cancer patients

2019 ◽  
Author(s):  
Jane Taggart ◽  
Melvin Chin ◽  
Winston Liauw ◽  
Alex Dolezal ◽  
John Plahn ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Information ◽  
Shared Care ◽  
Care Plan ◽  
Web Based ◽  
Care Plans ◽  
Cancer Services ◽  
Follow Up Care ◽  
Primary Care Practitioners

Abstract Introduction A shared model of care between cancer services and primary health care is safe and acceptable and can address the increasing demands on cancer services for long term follow-up. This paper describes the challenges developing an interactive shared care plan for colorectal cancer follow-up care that supports collaboration between the care team and patient. Methods A systematic literature review was undertaken to identify web-based care plans for follow-up cancer care that would inform the implementation of a system to share an individualised care plan. We conducted individual consultations with 25 key informants/stakeholders to understand the requirements and challenges of establishing the web-based care plan and to identify the technical options to share the care plan. This was followed by a structured group consultation with 13 key stakeholders to obtain agreement on the model of care and the technical solution to share the care plan. Results We identified five web-based shared care plans for cancer follow-up care. These systems supported the creation and/or access to view or share the care plan via internet log-in, email or hard copy. None of the SCP had interactive functionalities to support collaboration and none of the included papers reported formalised models of shared care between cancer services and primary care. The challenges identified included the security, privacy and sharing of patient information between public health services and primary health care and poor integration of clinical information systems. A primary care practitioners’ care planning system was selected for the pilot as it addressed the challenge of sharing clinical information between the public health system and external clinicians, partially addressed integration (integrated with the primary care clinical information systems but did not integrate with the cancer centre systems), supported collaboration between the care team and patient and was relatively inexpensive. Conclusion Primary care shared care planning systems seem a suitable option for sharing clinical information between a cancer service and primary care practitioners. We plan to evaluate the feasibility and acceptability of this interactive shared care plan to support shared cancer follow-up care.

scholarly journals Development of an interactive, web-based shared care plan to facilitate the follow-up care of colorectal cancer patients

2019 ◽  
Author(s):  
Jane Taggart ◽  
Melvin Chin ◽  
Winston Liauw ◽  
John Lewis ◽  
Alex Dolezal ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Information ◽  
Shared Care ◽  
Care Plan ◽  
Web Based ◽  
Care Plans ◽  
Cancer Services ◽  
Follow Up Care ◽  
Primary Care Practitioners

Abstract Introduction A shared model of care between cancer services and primary health care is safe and acceptable and can address the increasing demands on cancer services for long term follow-up. This paper describes the challenges developing an interactive shared care plan for colorectal cancer follow-up care. Methods A systematic literature review identified the use, functionality, and impact of web-based shared care plans to support cancer follow-up. Workshops with key stakeholders and consultations with clinicians, consumers and information service providers were conducted to agree on a model of care and technology options to interactively share a care plan. Results Seventeen papers reported five web-based shared care plan systems for cancer follow-up. These systems supported the creation and/or access to view or share the care plans using email or by downloading and printing a copy. The challenges we found included issues with the security, privacy and sharing of patient information between public health services and primary health care and poor integration of clinical information systems. We selected a primary care practitioners’ care planning system as it was interactive, integrated with primary care practitioner’ clinical information systems, was relatively inexpensive and addressed the sharing of clinical information with external clinicians to the public health system. Conclusion Primary care shared care planning systems seem a suitable option for sharing clinical information between a cancer service and primary care practitioners. We plan to evaluate the feasibility and acceptability of this interactive shared care plan to support shared cancer follow-up care.

Integrating the primary care physician into cancer follow-up.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 102-102 ◽  
Author(s):  
Andrew L. Salner ◽  
Deborah Walker ◽  
Amanda Seltzer ◽  
SarahLena Panzer ◽  
Carrie Stricker ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Primary Care Physician ◽  
Care Physician ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Plans ◽  
Follow Up Care

102 Background: After a diagnosis of breast cancer, it can be difficult for patients to understand the role their primary care physician (PCP) should play in their follow up care. Methods: 65 women (mean age 60 years, SD = 10) with breast cancer (stage 0-III) were seen by a nurse practitioner for a 60-90 minute consultative survivorship visit and received a treatment summary and personalized survivorship care plan (SCP) utilizing Carevive Care Planning Systems software. The Carevive system incorporates patient-reported and clinical data to create tailored care plans with personalized recommendations for follow up care and supportive referrals, including direction to follow up with primary care for specific care and health maintenance activities. Approximately 6 weeks following their survivorship care visit, patients completed a survey assessing their use of and satisfaction with the SCP. Patients were advised that the SCP would be mailed to their referring oncologist and primary care physician. Results: Out of 65 sent, 35 surveys have been completed to date. Survivors were diagnosed approximately 10 months prior, and all were within 6 months following completion of treatment. All patients (100%) reported that they read, or planned to read, their survivorship care plan packet carefully. While all care plans included a recommendation to follow up with their PCP, only (71%) of survivors remembered receiving this recommendation. Of those who did, most (74%) had either seen or scheduled an appointment with their PCP. Patients who reported higher anxiety at the time of the survivorship visit were more likely to report that the follow up care plan helped them take action about seeing their PCP (p = .03). Conclusions: Coordination between primary and oncology care providers has previously been shown to improve the quality of care for cancer survivors. SCPs that emphasize the importance of and activities to be undertaken in primary care may help to improve this coordination. Continuation of this research will help to better understand how to integrate the primary care physician into cancer follow up care. Updated data will be shared at time of presentation.

scholarly journals Creating an Age-Friendly Community in Affordable Housing Using a Resident Health Risk Assessment Focused on the 4Ms

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 49-49
Author(s):  
Jennifer DeGennaro ◽  
Sherry Pomerantz ◽  
Margaret Avallone ◽  
Melonie Handberry ◽  
Elyse Perweiler
Keyword(s):  
Risk Assessment ◽  
Health Risk ◽  
Health Risk Assessment ◽  
Affordable Housing ◽  
Risk Function ◽  
Well Being ◽  
Screening Tools ◽  
Care Plan ◽  
Care Plans

Abstract The NJGWEP team in partnership with Fair Share Housing/Northgate II (NGII), an affordable housing complex in Camden, NJ, employed an iterative quality improvement process to collaboratively develop a Resident Health Risk Assessment (RHRA) to meet the needs of the housing facility and incorporate the essential elements of the 4Ms framework (Mentation, Medication, Mobility, and What Matters). Using the RHRA, NG II social services staff and Rutgers School of Nursing (RSoN) students were trained to collect health information and administer several evidence-based screening tools (i.e., MiniCog, TUG, PHQ-2). A final element of the RHRA still in development is the documentation process of referral and follow-up based on personalized care plans. Since July 2019, 43 RHRAs have been completed (60% female, mean age 66, age range=43 to 88). Almost all residents (94%) have at least 1 chronic condition (HTN, DM, COPD, CHF), although only 26% have an advance care plan. Most (81%) were screened for future fall risk; function (ADLs/IADLs) was assessed for all (100%). Every resident who was able or did not refuse (88%) was screened for cognitive impairment. Just 7% were taking a high-risk medication (i.e., an opioid or benzodiazepine). The NJGWEP team has initiated an age-friendly community at NGII by providing education on geriatric-focused topics and implementing the 4Ms-focused RHRA to detect issues impacting the resident’s well-being. Establishing a follow-up process to track referrals to available resources will enable NGII to allow residents to age in place with appropriate supports.

scholarly journals Outpatient services and primary care: scoping review, substudies and international comparisons

2016 ◽  
Vol 4 (15) ◽  
pp. 1-290 ◽  
Author(s):  
Eleanor Winpenny ◽  
Céline Miani ◽  
Emma Pitchforth ◽  
Sarah Ball ◽  
Ellen Nolte ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Scoping Review ◽  
Secondary Care ◽  
Outpatient Services ◽  
Community Based ◽  
Educational Value ◽  
New Models ◽  
Effectiveness And Efficiency

AimThis study updates a previous scoping review published by the National Institute for Health Research (NIHR) in 2006 (Roland M, McDonald R, Sibbald B.Outpatient Services and Primary Care: A Scoping Review of Research Into Strategies For Improving Outpatient Effectiveness and Efficiency. Southampton: NIHR Trials and Studies Coordinating Centre; 2006) and focuses on strategies to improve the effectiveness and efficiency of outpatient services.Findings from the scoping reviewEvidence from the scoping review suggests that, with appropriate safeguards, training and support, substantial parts of care given in outpatient clinics can be transferred to primary care. This includes additional evidence since our 2006 review which supports general practitioner (GP) follow-up as an alternative to outpatient follow-up appointments, primary medical care of chronic conditions and minor surgery in primary care. Relocating specialists to primary care settings is popular with patients, and increased joint working between specialists and GPs, as suggested in the NHS Five Year Forward View, can be of substantial educational value. However, for these approaches there is very limited information on cost-effectiveness; we do not know whether they increase or reduce overall demand and whether the new models cost more or less than traditional approaches. One promising development is the increasing use of e-mail between GPs and specialists, with some studies suggesting that better communication (including the transmission of results and images) could substantially reduce the need for some referrals.Findings from the substudiesBecause of the limited literature on some areas, we conducted a number of substudies in England. The first was of referral management centres, which have been established to triage and, potentially, divert referrals away from hospitals. These centres encounter practical and administrative challenges and have difficulty getting buy-in from local clinicians. Their effectiveness is uncertain, as is the effect of schemes which provide systematic review of referrals within GP practices. However, the latter appear to have more positive educational value, as shown in our second substudy. We also studied consultants who held contracts with community-based organisations rather than with hospital trusts. Although these posts offer opportunities in terms of breaking down artificial and unhelpful primary–secondary care barriers, they may be constrained by their idiosyncratic nature, a lack of clarity around roles, challenges to professional identity and a lack of opportunities for professional development. Finally, we examined the work done by other countries to reform activity at the primary–secondary care interface. Common approaches included the use of financial mechanisms and incentives, the transfer of work to primary care, the relocation of specialists and the use of guidelines and protocols. With the possible exception of financial incentives, the lack of robust evidence on the effect of these approaches and the contexts in which they were introduced limits the lessons that can be drawn for the English NHS.ConclusionsFor many conditions, high-quality care in the community can be provided and is popular with patients. There is little conclusive evidence on the cost-effectiveness of the provision of more care in the community. In developing new models of care for the NHS, it should not be assumed that community-based care will be cheaper than conventional hospital-based care. Possible reasons care in the community may be more expensive include supply-induced demand and addressing unmet need through new forms of care and through loss of efficiency gained from concentrating services in hospitals. Evidence from this study suggests that further shifts of care into the community can be justified only if (a) high value is given to patient convenience in relation to NHS costs or (b) community care can be provided in a way that reduces overall health-care costs. However, reconfigurations of services are often introduced without adequate evaluation and it is important that new NHS initiatives should collect data to show whether or not they have added value, and improved quality and patient and staff experience.FundingThe NIHR Health Services and Delivery Research programme.

scholarly journals What are the opportunities for cancer care and related research in primary care? A qualitative study of the views of patients, carers, and practice staff

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703505
Author(s):  
Joseph Clark ◽  
Elvis Amoakwa ◽  
John Blenkinsopp ◽  
Florence Reedy ◽  
Miriam Johnson
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Cancer Care ◽  
Information Needs ◽  
Controlled Trial ◽  
Unmet Need ◽  
Care Staff ◽  
Trial Participation

BackgroundResearch to identify the role of primary care in cancer care is important. However, trials in primary care are difficult.AimTo understand how patients, families, and primary care clinicians view their role in cancer care and identify opportunities for cancer primary care research.MethodQualitative study embedded within a feasibility cluster randomised controlled trial of a primary care based needs assessment intervention. The Supportive Cancer Needs Survey (SCNS) was the main outcome. In-depth interviews with patients/carers and focus groups with primary care staff explored views on cancer care and trial participation. Data were recorded, transcribed verbatim, and analysed thematically by three independent researchers.ResultsFifteen cancer patients and three carers were interviewed and four focus groups (n = 11) were conducted. Three themes were generated satisfaction with current care; key time-points for improved cancer care; and information and research. Satisfaction with current care among patients was high in spite of 72% reporting at least one moderate-high unmet need at baseline. Most patients undergoing cancer treatment were unsure when to access primary care. Patients and carers highly valued proactive contact from their practice following diagnosis though this was uncommon. Post-oncology discharge was a key time-point for information needs and support for patients. Patients were reluctant to consider palliative care in spite of palliative care needs. Some felt therapeutic benefit from completing study measures.ConclusionPatients are satisfied with cancer primary care despite unmet needs. Palliative care is poorly understood by many who may benefit. Research participation may benefit some patients.

scholarly journals Are Care Plans Suitable for the Management of Multiple Conditions?

2016 ◽  
Vol 6 (2) ◽  
pp. 103-113 ◽  
Author(s):  
Charlotte E. Young ◽  
Frances M. Boyle ◽  
Allyson J. Mutch
Keyword(s):  
Primary Care ◽  
Patient Preferences ◽  
Care Plan ◽  
Care Practice ◽  
Multiple Chronic Conditions ◽  
Comorbid Conditions ◽  
Care Needs ◽  
Care Plans ◽  
Number Of Patients ◽  
Multiple Conditions

Background Care plans have been part of the primary care landscape in Australia for almost two decades. With an increasing number of patients presenting with multiple chronic conditions, it is timely to consider whether care plans meet the needs of patients and clinicians. Objectives To review and benchmark existing care plan templates that include recommendations for comorbid conditions, against four key criteria: (i) patient preferences, (ii) setting priorities, (iii) identifying conflicts and synergies between conditions, and (iv) setting dates for reviewing the care plan. Design Document analysis of Australian care plan templates published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Results Sixteen templates were reviewed. All of the care plan templates addressed patient preference, but this was not done comprehensively. Only three templates included setting priorities. None assisted in identifying conflicts and synergies between conditions. Fifteen templates included setting a date for reviewing the care plan. Conclusions Care plans are a well-used tool in primary care practice, but their current format perpetuates a single-disease approach to care, which works contrary to their intended purpose. Restructuring care plans to incorporate shared decision-making and attention to patient preferences may assist in shifting the focus back to the patient and their care needs.

scholarly journals Do care plans and annual reviews of physical health influence unplanned hospital utilisation for people with serious mental illness? Analysis of linked longitudinal primary and secondary healthcare records in England

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023135 ◽  
Author(s):  
Jemimah Ride ◽  
Panagiotis Kasteridis ◽  
Nils Gutacker ◽  
Christoph Kronenberg ◽  
Tim Doran ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Physical Health ◽  
Serious Mental Illness ◽  
Care Quality ◽  
Care Plan ◽  
Care Plans ◽  
Primary Care Quality ◽  
Hospital Utilisation ◽  
Reduced Risk

ObjectiveTo investigate whether two primary care activities that are framed as indicators of primary care quality (comprehensive care plans and annual reviews of physical health) influence unplanned utilisation of hospital services for people with serious mental illness (SMI).Design, setting, participantsRetrospective observational cohort study using linked primary care and hospital records (Hospital Episode Statistics) for 5158 patients diagnosed with SMI between April 2006 and March 2014, who attended 213 primary care practices in England that contribute to the Clinical Practice Research Datalink GOLD database.Outcomes and analysisCox survival models were used to estimate the associations between two primary care quality indicators (care plans and annual reviews of physical health) and the hazards of three types of unplanned hospital utilisation: presentation to accident and emergency departments (A&E), admission for SMI and admission for ambulatory care sensitive conditions (ACSC).ResultsRisk of A&E presentation was 13% lower (HR 0.87, 95% CI 0.77 to 0.98) and risk of admission to hospital for ACSC was 23% lower (HR 0.77, 95% CI 0.60 to 0.99) for patients with a care plan documented in the previous year compared with those without a care plan. Risk of A&E presentation was 19% lower for those who had a care plan documented earlier but not updated in the previous year (HR: 0.81, 95% CI 0.67 to 0.97) compared with those without a care plan. Risks of hospital admission for SMI were not associated with care plans, and none of the outcomes were associated with annual reviews.ConclusionsCare plans documented in primary care for people with SMI are associated with reduced risk of A&E attendance and reduced risk of unplanned admission to hospital for physical health problems, but not with risk of admission for mental health problems. Annual reviews of physical health are not associated with risk of unplanned hospital utilisation.

Ensuring head and neck oncology patients receive recommended pretreatment dental evaluations.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 100-100
Author(s):  
Danielle Nina Margalit ◽  
Stephanie Losi ◽  
Roy B. Tishler ◽  
Jonathan Daniel Schoenfeld ◽  
JoAnn Fugazzotto ◽  
...  
Keyword(s):  
Head And Neck ◽  
Dental Care ◽  
Care Plan ◽  
Community Based ◽  
Pareto Chart ◽  
Care Plans ◽  
Primary Responsibility ◽  
Pre Treatment

100 Background: Pre-treatment dental evaluations are recommended for head and neck (H&N) cancer patients (pts) prior to radiation therapy (RT) to minimize the risk of acute and long-term side effects of treatment. We previously created a dental instructional guide (DIG) outlining the necessary components of the pre-radiation dental evaluation for pts undergoing community-based dental evaluation. Yet our program did not have a system for documenting which pts received the DIG. We aimed to create a system to ensure that pts are given the DIG early in their care-plan and that such pts are readily identifiable so we can follow-up and confirm that the recommended dental care is complete prior to starting RT. Methods: Chart review was performed to determine the percentage of eligible pts with documented provision of the DIG. A diagnostic survey of H&N oncology clinicians was analyzed with a Pareto chart to determine common barriers to DIG provision and documentation. Clinicians were surveyed on potential ways to document DIG provision to eligible pts. The Model for Improvement and DMAIC (Six Sigma) methodologies were used and multiple Plan-Do-Study-Act (PDSA) cycles were performed to implement the intervention and monitor change. Change data was analyzed using a P-chart, 3-sigma. Results: We used a process map to identify 3 potential care-plans within the H&N oncology program and assist in defining which providers had primary responsibility for providing the DIG. We then designed and implemented a template within the electronic medical record that documents the clinician who gave the DIG and the date it was given. There was an improvement in the rate of DIG documentation from a baseline of 0% (range 0-0%) to a mean of 40% (range 0-100%) over 3-months (p<0.01). This improvement was sustained through last follow-up at 5 months. Conclusions: Through a multidisciplinary approach, we implemented an intervention to identify pts undergoing community-based dental evaluation prior to RT for H&N cancer. Further efforts are focused on increasing the DIG documentation rate and increasing our interaction with community dentists to promote expeditious pre-radiation dental care.

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