4R Care Delivery Program results: Impact of implementation metrics on patient self-management and 4R usefulness.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14039-e14039
Author(s):  
Julia Rachel Trosman ◽  
Christine B. Weldon ◽  
Della F. Makower ◽  
Bruce D. Rapkin ◽  
Claudia B. Perez ◽  
...  
Keyword(s):  
Care Delivery ◽  
Care Patient ◽  
Historical Control ◽  
Care Process ◽  
Self Management ◽  
Control Cohort ◽  
Patient Navigators ◽  
Care Delivery Model ◽  
Program Step ◽  
The Impact

e14039 Background: We previously proposed a 4R care delivery model that facilitates teamwork and patient self-management (pSM) in cancer care (NCI ASCO Teams Project, Trosman JOP 2016). 4R (Right Info / Care / Patient / Time) enables patient and care team to manage complex care with an innovative 4R Care Sequence. We tested 4R at 10 US sites in a stepwise mode 2016-2019. Methods: Step 1 included 1 academic and 2 nonacademic sites; step 2 included 3 academic and 4 nonacademic sites. Patients with stage 0-III breast cancer received 4R Sequences (4R Cohort). We surveyed 4R and historical control cohorts of patients treated at the same sites pre-4R. We assessed the impact of implementation metrics on usefulness of 4R to the 4R cohort and on improvement of pSM in 4R cohort vs historical control cohort. Results: Survey response rates: 63%, 422/670 (4R cohort); 47%, 466/992 (control cohort). Three of the five implementation metrics significantly impacted patient usefulness of 4R (Table). Patients at step 2 sites; sites with a systematic care process; and sites with small practices reported significantly higher 4R usefulness than patients in the comparison subgroup within respective metrics. 4R usefulness was not affected by practice setting or availability of patient navigators. pSM was significantly improved between control and 4R cohorts along all implementation metrics (p < .001), but the magnitude of incremental improvement between comparison subgroups varied across metrics (Table), with the largest increment associated with the program step metric. Conclusions: 4R is useful to patients across settings, with or without patient navigators. Stepwise design is effective in increasing 4R impact overtime. Future 4R Program will investigate an expanded array of implementation metrics and their influence on 4R outcomes. [Table: see text]

4R Care Delivery Program results: Impact of implementation metrics on patient self-management and 4R usefulness.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 225-225
Author(s):  
Julia Rachel Trosman ◽  
Christine B. Weldon ◽  
Della F. Makower ◽  
Bruce D. Rapkin ◽  
Claudia Beth Perez ◽  
...  
Keyword(s):  
Care Delivery ◽  
Care Patient ◽  
Historical Control ◽  
Care Process ◽  
Self Management ◽  
Control Cohort ◽  
Patient Navigators ◽  
Care Delivery Model ◽  
Program Step ◽  
The Impact

225 Background: We previously proposed a 4R care delivery model that facilitates teamwork and patient self-management (pSM) in cancer care (NCI ASCO Teams Project, Trosman JOP 2016). 4R (Right Info / Care / Patient / Time) enables patient and care team to manage complex care with an innovative 4R Care Sequence. We tested 4R at 10 US sites in a stepwise mode 2016-2019. Methods: Step 1 included 1 academic and 2 nonacademic sites; step 2 included 3 academic and 4 nonacademic sites. Patients with stage 0-III breast cancer received 4R Sequences (4R Cohort). We surveyed 4R and historical control cohorts of patients treated at the same sites pre-4R. We assessed the impact of implementation metrics on usefulness of 4R to the 4R cohort and on improvement of pSM in 4R cohort vs historical control cohort. Results: Survey response rates: 63%, 422/670 (4R cohort); 47%, 466/992 (control cohort). Three of the five implementation metrics significantly impacted patient usefulness of 4R (Table). Patients at step 2 sites; sites with a systematic care process; and sites with small practices reported significantly higher 4R usefulness than patients in the comparison subgroup within respective metrics. 4R usefulness was not affected by practice setting or availability of patient navigators. pSM was significantly improved between control and 4R cohorts along all implementation metrics (p < .001), but the magnitude of incremental improvement between comparison subgroups varied across metrics (Table), with the largest increment associated with the program step metric. Conclusions: 4R is useful to patients across settings, with or without patient navigators. Stepwise design is effective in increasing 4R impact overtime. Future 4R Program will investigate an expanded array of implementation metrics and their influence on 4R outcomes. [Table: see text]

Does the innovative 4R Cancer Care Delivery Model improve patient self-management in safety net and non-safety net centers?

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 172-172
Author(s):  
Julia Rachel Trosman ◽  
William John Gradishar ◽  
Della F. Makower ◽  
Bruce D. Rapkin ◽  
Moreen Bozier ◽  
...  
Keyword(s):  
Care Delivery ◽  
Safety Net ◽  
Care Patient ◽  
Self Management ◽  
Control Cohort ◽  
Similar Extent ◽  
Care Delivery Model ◽  
The Us ◽  
Care Project ◽  
Improve Patient

172 Background: Under the NCI ASCO Teams Project, we proposed a 4R Model of teamwork and patient self-management (pSM) (Trosman JOP ’16). 4R (Right Info/Care/Patient/Time) enables patient (pt) and care team to manage complex care continuum with an innovative multimodality 4R Care Project Plan. 4R includes a novel “project” feature – a graphical description of care interdependencies. 4R was previously piloted at 3 Chicago centers (Trosman ASCO ‘18). Methods: In this new study, we improved and tested 4R for impact on pSM at 4 safety net and 3 non safety net centers across the US. 4R Plans were provided to stage 0-III breast cancer pts Jan - Nov’18 (4R cohort). We surveyed the 4R cohort and a historical control cohort of pts who received care at same centers pre-4R, Jan - Dec ’17. Results: Survey response rates: 65%, 105/162 (4R cohort); 44%, 190/432 (control). 4R markedly improved 4 of 5 pSM metrics vs control (Table). Additional analyses showed that safety net pts had a significant increase in 4R vs control cohort in “seldom overwhelmed” (84%, 49/58 vs 64%, 67/104 respectively, p = .007), while non safety net pts had nonsignificant increase. Other metrics improved to a similar extent for safety net vs non safety net pts. Within the 4R cohort, 85% found 4R useful in organizing their care and 73% found 4R’s novel “project” feature useful in understanding care interdependencies. Safety net pts reported similar usefulness of 4R in organizing their care as non safety net pts (88%, 51/58 vs 81%, 38/47, NS) and similar usefulness of the “project’ feature in understanding care interdependencies as non safety net pts (74% vs. 72%, NS). Conclusions: 4R significantly improved patient self-management, but further efforts are needed to expand the benefit to as close to a 100% of pts as feasible. Safety net pts benefited from 4R at similar or higher rates than non safety net pts, indicating that 4R may reduce care disparities. An expansion of 4R across the US continues this work. [Table: see text]

Does the innovative 4R Cancer Care Delivery Model improve patient self-management in safety net and non-safety net centers?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6601-6601
Author(s):  
Julia Rachel Trosman ◽  
Christine B. Weldon ◽  
Della F. Makower ◽  
Bruce D. Rapkin ◽  
Moreen Bozier ◽  
...  
Keyword(s):  
Care Delivery ◽  
Safety Net ◽  
Care Patient ◽  
Self Management ◽  
Control Cohort ◽  
Similar Extent ◽  
Care Delivery Model ◽  
The Us ◽  
Improve Patient ◽  
Work Table

6601 Background: Under the NCI ASCO Teams Project, we proposed a 4R Model of teamwork and patient self-management (pSM) (Trosman JOP ’16). 4R (Right Info / Care / Patient / Time) enables patient (pt) and care team to manage complex care continuum with an innovative multimodality 4R Care Project Plan. 4R includes a novel “project” feature – a graphical description of care interdependencies. 4R was previously piloted at 3 Chicago centers (Trosman ASCO ‘18). Methods: In this new study, we improved and tested 4R for impact on pSM at 4 safety net and 3 non safety net centers across the US. 4R Plans were provided to stage 0-III breast cancer pts Jan - Nov’18 (4R cohort). We surveyed the 4R cohort and a historical control cohort of pts who received care at same centers pre-4R, Jan - Dec ’17. Results: Survey response rates: 65%, 105/162 (4R cohort); 44%, 190/432 (control). 4R markedly improved 4 of 5 pSM metrics vs control (Table). Additional analyses showed that safety net pts had a significant increase in 4R vs control cohort in “seldom overwhelmed” (84%, 49/58 vs 64%, 67/104 respectively, p = .007), while non safety net pts had nonsignificant increase. Other metrics improved to a similar extent for safety net vs non safety net pts. Within the 4R cohort, 85% found 4R useful in organizing their care and 73% found 4R’s novel “project” feature useful in understanding care interdependencies. Safety net pts reported similar usefulness of 4R in organizing their care as non safety net pts (88%, 51/58 vs 81%, 38/47, NS) and similar usefulness of the “project’ feature in understanding care interdependencies as non safety net pts (74% vs. 72%, NS). Conclusions: 4R significantly improved patient self-management, but further efforts are needed to expand the benefit to as close to a 100% of pts as feasible. Safety net pts benefited from 4R at similar or higher rates than non safety net pts, indicating that 4R may reduce care disparities. An expansion of 4R across the US continues this work. [Table: see text]

4R Program results: What is the impact of 4R care delivery model on patient self-management and which patients benefited?

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19211-e19211
Author(s):  
Julia Rachel Trosman ◽  
Christine B. Weldon ◽  
Della F. Makower ◽  
Bruce D. Rapkin ◽  
Moreen Bozier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Care Delivery ◽  
Age Groups ◽  
Safety Net ◽  
Care Patient ◽  
Self Management ◽  
Visual Feature ◽  
Control Cohort ◽  
Historical Cohort ◽  
The Impact

e19211 Background: We previously proposed a 4R model of teamwork and patient self-management (pSM) in cancer care (NCI ASCO Teams Project, Trosman JOP 2016). 4R (Right Info / Care / Patient / Time) enables patient and care team to manage complex care with an innovative 4R Care Sequence plan, including a novel visual feature describing timing and sequence of care. We report final results of a program which tested 4R at 5 safety net and 5 non safety net US centers from 2016 to 2019. Methods: Patients with stage 0-III breast cancer received 4R plans (4R Cohort). We surveyed 4R cohort and a historical control cohort of patients receiving care at same centers pre-4R. We assessed the usefulness of 4R to the 4R cohort and the impact on pSM in 4R cohort compared to historical cohort. Results: Survey response rates: 63%, 422/670 (4R cohort); 47%, 466/992 (control). 4R significantly increased the composite pSM score and 5 of 7 pSM metrics vs control (Table). The increase was not influenced by patient age, stage or whether treated at safety net site. pSM scores increased in 4R vs control cohort to a similar extent for patients < 65 years old (74% vs 51%, p = .0001) as for patients ≥ 65 years old (78% vs 57%, p = .0002). pSM improved similarly for patients with stage 0 or I breast cancer (77% vs 56%, p = .0001) as for patients with stage II or III breast cancer (72% vs 54%, p = .0001). Safety net patients showed pSM increase (77% vs 51%, p = .0001) similar to non safety net patients (74% vs 58%, p = .0002). Within the 4R cohort, 80% found 4R useful for organizing care and 70% found the novel visual feature useful to manage care timing and sequence. Usefulness was similar for age groups and stages, but higher for safety net than non safety net patients (88% vs 74%, p = .0008). Conclusions: 4R markedly improved patient self-management in early breast cancer across age groups and cancer stages, but further enhancements are needed to benefit as many patients as possible. 4R benefits in safety net setting indicate that 4R may reduce disparities. [Table: see text]

4R program results: What is the impact of 4R care delivery model on patient self-management and which patients benefited?

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 139-139
Author(s):  
Julia Rachel Trosman ◽  
Christine B. Weldon ◽  
Della F. Makower ◽  
Bruce D. Rapkin ◽  
Moreen Bozier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Care Delivery ◽  
Age Groups ◽  
Safety Net ◽  
Care Patient ◽  
Self Management ◽  
Visual Feature ◽  
Control Cohort ◽  
Historical Cohort ◽  
The Impact

139 Background: We previously proposed a 4R model of teamwork and patient self-management (pSM) in cancer care (NCI ASCO Teams Project, Trosman JOP 2016). 4R (Right Info/Care/Patient/Time) enables patient and care team to manage complex care with an innovative 4R Care Sequence plan, including a novel visual feature describing timing and sequence of care. We report final results of a program which tested 4R at 5 safety net and 5 non safety net US centers from 2016 to 2019. Methods: Patients with stage 0-III breast cancer received 4R plans (4R Cohort). We surveyed 4R cohort and a historical control cohort of patients receiving care at same centers pre-4R. We assessed the usefulness of 4R to the 4R cohort and the impact on pSM in 4R cohort compared to historical cohort. Results: Survey response rates: 63%, 422/670 (4R cohort); 47%, 466/992 (control). 4R significantly increased the composite pSM score and 5 of 7 pSM metrics vs control (Table). The increase was not influenced by patient age, stage or whether treated at safety net site. pSM scores increased in 4R vs control cohort to a similar extent for patients < 65 years old (74% vs 51%, p = .0001) as for patients ≥ 65 years old (78% vs 57%, p = .0002). pSM improved similarly for patients with stage 0 or I breast cancer (77% vs 56%, p = .0001) as for patients with stage II or III breast cancer (72% vs 54%, p = .0001). Safety net patients showed pSM increase (77% vs 51%, p = .0001) similar to non safety net patients (74% vs 58%, p = .0002). Within the 4R cohort, 80% found 4R useful for organizing care and 70% found the novel visual feature useful to manage care timing and sequence. Usefulness was similar for age groups and stages, but higher for safety net than non safety net patients (88% vs 74%, p = .0008). Conclusions: 4R markedly improved patient self-management in early breast cancer across age groups and cancer stages, but further enhancements are needed to benefit as many patients as possible. 4R benefits in safety net setting indicate that 4R may reduce disparities. [Table: see text]

Results from a pilot of an innovative 4R Cancer Care Delivery Model: Impact on patient self-management.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 224-224
Author(s):  
Julia Rachel Trosman ◽  
Christine B. Weldon ◽  
Claudia B. Perez ◽  
Swati Kulkarni ◽  
Seema Ahsan Khan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Care Delivery ◽  
Safety Net ◽  
Academic Community ◽  
Community Safety ◽  
Self Management ◽  
Control Cohort ◽  
Historical Cohort ◽  
Care Services ◽  
The Impact

224 Background: Under the “NCI ASCO Teams” Project, we proposed a 4R Model of teamwork and patient self-management (pSM) (Trosman JOP ’16). 4R is Right Info / Care / Patient / Time. It enables patient (pt) and care team to manage interdependent care along the care continuum with an innovative multimodality personalized 4R Care Project Plan. We piloted 4R at 3 centers (academic, community, safety net) and assessed its impact on pSM. Methods: 4R Plans were administered to breast cancer pts stage 0-III Sep ’16 – Aug ’17 (4R cohort). We surveyed the 4R cohort and a comparable historical cohort of pts who received care pre-4R, Jun ’15 – May ’16 (control). We used simple frequencies and Fisher’s exact test in analyses. Results: Survey response rates: 68%, 185/271 (4R cohort); 47%, 241/410 (control). 75% of 4R respondents reported 4R Plans very useful / useful in overall understanding and organizing their care; 68% found 4R’s novel “project” component, very useful / useful in managing timing & sequencing of interdependent care. Care complexity impacted 4R usefulness: 67% of pts who received > 6 care services found 4R very useful / useful vs. 47% of pts who received < = 6 services, p = .01. Pts with lower care complexity suggested how to make 4R more useful to them, eg focus on endocrine therapy. Table compares pSM metrics in the 4R and control cohort. Care complexity was a significant factor of feeling overwhelmed for pts in the control cohort (51% of pts receiving > 6 care services felt overwhelmed vs. 31% of pts receiving < = 6 services, p = .02), but not a significant factor for pts in the 4R cohort (30% vs. 28%, p = .9). Conclusions: The 4R model significantly improved pt self-management in early breast cancer and reduced the impact of care complexity on pts, but provider factors of pSM need improvement. A 4R pilot at additional 12 cancer centers across the U.S. is in progress.[Table: see text]

scholarly journals IMPACTO DA PARCERIA DE CUIDADOS PARA A CRIANÇA HOSPITALIZADA E SUA FAMÍLIA

2017 ◽  
Vol 3 (1) ◽  
pp. 225
Author(s):  
Rosa Mª Correia Jerónimo Pedroso
Keyword(s):  
Home Environment ◽  
Care Delivery ◽  
Care Process ◽  
Hospitalized Children ◽  
Exclusion Criteria ◽  
Good Communication ◽  
Online Databases ◽  
Hospitalization Period ◽  
Nursing Team ◽  
The Impact

Abstract.IMPACT OF THE CARE PARTNERHIP ON HOSPITALIZED CHILDREN AND THEIR FAMILIESBackground - For children, hospital admission often means to be removed from their home environment, their daily activities, and their friends. The care partnership is considered to be essential in the child’s hospitalization process, resulting in benefits not only for children and their families but also for healthcare professionals.Objective - To identify the impact of the nursing care partnership on hospitalized children and their families.Methods - A systematic literature review was conducted. After application of the inclusion/exclusion criteria, a search performed in the online databases EBSCOhost, b-on, and SciELO revealed 5 primary studies published between 2005 and 2014 that addressed the research question.Results- The results showed that both children and their families benefit from the care partnership, to the extent that the opportunity to be involved in care delivery reduces their anxiety levels, increases their feeling of independence, promotes a good communication with the nursing team, brings about feelings of peace and reassurance, and facilitates the adaptation to the child’s new health condition.Conclusions- The nursing team is responsible for including family members in the care process, encouraging their presence and active participation and allowing them to provide emotional support and safety to the hospitalized child. Their presence throughout the hospitalization period is essential to minimize its impact on children and their families.Keywords: Care partnership, integration into care, participation in care, parents, family, pediatrics, child.Resumo.Antecedentes- O período de hospitalização representa muitas vezes para a criança o afastamento do seu ambiente familiar, das suas actividades diárias e dos seus amigos, pelo que a parceria de cuidados é reconhecida como essencial no seu processo de hospitalização, trazendo benefícios quer para a criança e sua família, quer para a equipa de profissionais de saúde.Objectivo- Conhecer o impacto da parceria de cuidados de enfermagem para as crianças hospitalizadas e suas famílias.Metodologia- Trata-se de uma Revisão Sistemática da Literatura. Após os critérios de incluso e exclusão foram seleccionados 5 artigos primários, publicados entre 2005-2014 e pesquisados nas plataformas eletrónicas: EBSCOhost, b-on e SciELO, que deram resposta à questão de revisão.Resultados- Os resultados obtidos demonstraram que a parceria de cuidados é benéfica tanto para a criança como para a sua família, na medida em que a oportunidade de participação nos cuidados, diminuios níveis de ansiedade, aumenta o sentimento de independência, promove uma comunicação adequada com a equipa de enfermagem, sentimentos de paz e encorajamento e facilita a adaptação à nova condição de saúde da criança.Conclusões- Cabe à equipa de enfermagem incluir a família no processo de cuidados, permitindo a sua presença e o seu envolvimento ativo, dando a possibilidade aos familiares de prestar apoio emocional e segurança à criança hospitalizada. O acompanhamento ao longo de todo o processo de internamento é crucial para minimizar o impacto da hospitalização na criança e na sua família.Palavras-chave: Parceria de cuidados, integração nos cuidados, participação nos cuidados, pais, família, pediatria e criança.

scholarly journals Effectiveness of IT-based interventions on self-management in adult kidney transplant recipients: a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saeid Eslami ◽  
Farnaz Khoshrounejad ◽  
Reza Golmakani ◽  
Zhila Taherzadeh ◽  
Fariba Tohidinezhad ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Kidney Transplant ◽  
Care Process ◽  
Self Management ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Adult Kidney ◽  
The Impact ◽  
Positive Effect

Abstract Background Kidney transplant outcomes are broadly associated with transplant recipients’ capacity in following a complex and continuous self-management regimen. Health information technology has the potential to empower patients. This systematic review aimed to determine the impacts of IT-based interventions for self-management in kidney transplant recipients. Methods A comprehensive investigation was performed in MEDLINE (via PubMed) and EMBASE (via Scopus) in April 2019. Eligible studies were the randomized controlled trials which aimed to design an automated IT-based intervention. All English papers including adult kidney transplant recipients were included. To assess the clinical trial’s quality, Cochrane Collaboration’s assessment tool was employed. The articles were integrated based on category of outcomes, characteristics of interventions, and their impact. The interventions were classified based on the used IT-based tools, including smart phones, coverage tools, computer systems, and a combination of several tools. The impact of interventions was defined as: (1) positive effect (i.e. statistically significant), and (2) no effect (i.e. not statistically significant). Results A total of 2392 articles were retrieved and eight publications were included for full-text analysis. Interventions include those involving the use of computerized systems (3 studies), smart phone application (3 studies), and multiple components (2 studies). The studies evaluated 30 outcomes in total, including 24 care process and 6 clinical outcomes. In 18 (80%) out of 30 outcomes, interventions had a statistically significant positive effect, 66% in process and 33% in clinical outcomes. Conclusions IT-based interventions (e.g. mobile health applications, wearable devices, and computer systems) can improve self-management in kidney transplant recipients (including clinical and care process outcomes). However, further evaluation studies are required to quantify the impact of IT-based self-management interventions on short- and long-term clinical outcomes as well as health care costs and patients' quality of life.

4R Program results in breast cancer: the impact of 4R Care Delivery Model on timing and sequence of guideline recommended care.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 573-573
Author(s):  
Christine B. Weldon ◽  
Julia Rachel Trosman ◽  
Della F. Makower ◽  
Bruce D. Rapkin ◽  
Claudia Beth Perez ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Smoking Cessation ◽  
Care Delivery ◽  
Patient Survey ◽  
Breast Cancer Patients ◽  
Recommended Care ◽  
Delivery Model ◽  
Care Delivery Model ◽  
Patient Reported ◽  
The Impact

573 Background: We previously proposed a 4R care delivery model which enables patients and care teams to manage timing and sequence of interdependent, time sensitive care with a novel multimodality 4R Care Sequence plan (NCI ASCO Teams Project; Trosman, JOP 2016). We report final results of a program which tested 4R at 10 US centers (4 academic and 6 non-academic) from 2016 to 2019. Methods: 4R Sequences were provided to stage 0-III breast cancer patients (4R cohort, N = 422) at participating centers. Analyses of clinical and patient-reported data compared the 4R cohort to a historical control cohort of patients who received care pre-4R at the same centers (N = 466). Results: We significantly improved 5 guideline recommended referral metrics and 4 referral completion metrics indicating receipt of care by patients who were referred (Table). Although significantly increased, referrals to dental visit and smoking cessation before treatment remained low (< 20% and < 10% respectively). Patient survey comments indicated that insufficient lead time to quit smoking or obtain fertility consult before cancer treatment was a key barrier for completing these referrals. Conclusions: 4R markedly improved referral and receipt of interdependent guideline recommended breast cancer care for most metrics. Future 4R program should optimize the timing of referrals within the 4R Care Sequence to allow sufficient time for smoking cessation and fertility care before treatment initiation. [Table: see text]

Does the innovative 4R Care Delivery Model improve timing and sequencing of guideline recommended breast cancer care in safety net and non-safety net centers?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 562-562
Author(s):  
Christine B. Weldon ◽  
Julia Rachel Trosman ◽  
Della F. Makower ◽  
Bruce D. Rapkin ◽  
Moreen Bozier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Care Delivery ◽  
Safety Net ◽  
Similar Rate ◽  
Care Patient ◽  
Control Cohort ◽  
Breast Cancer Care ◽  
Recommended Care ◽  
Reported Data

562 Background: Under the NCI ASCO Teams Project, we proposed a 4R Model which enables patient (pt) and care team to manage timing and sequencing of interdependent care with a novel multimodality 4R Care Project Plan (Trosman JOP ’16). 4R (Right Info/Care/Patient/Time) was previously piloted at 3 Chicago centers (Weldon ASCO ‘18). Methods: A new study tested impact of 4R on timing and sequencing of guideline recommended care at 4 safety net and 3 non safety net US centers. 4R Plans were provided to stage 0-III breast cancer pts Jan-Nov’18, 4R cohort. Clinical and pt reported data analyses compared 4R cohort (N=105) to a historical control cohort of pts who received care pre-4R, Jan - Dec ’17 (N=190). Results: We significantly improved 3 referral metrics and 4 referral completion metrics - receipt of care by pts who were referred (Table). After referrals, safety net pts had a significant increase in 4R vs control cohort in receiving genetic consult (72%, 21/29 vs. 42%, 18/43, p=.02) and dental visit (100%, 6/6 vs. 20%, 1/5, p=.02). They had lower increases in flu shot referrals (41%, 24/58, vs 36%, 37/104, NS) and dental referrals (10%, 6/58, vs 5%, 5/104, NS) than non safety net pts who had significant increases. Other metrics improved at a similar rate for safety net and non safety net pts. Conclusions: 4R markedly improved referral and receipt of interdependent guideline recommended breast cancer care. For most metrics safety net pts benefited from 4R at a similar or higher rate than non safety net pts, indicating that 4R may reduce care disparities. Low increases in referrals for safety net pts and in trial referral/enrollment for all pts must be addressed. An expansion of 4R across the US continues this work. [Table: see text]

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