Evaluation of the Novel 4R Oncology Care Planning Model in Breast Cancer: Impact on Patient Self-Management and Care Delivery in Safety-Net and Non–Safety-Net Centers

2021 ◽  
Vol 17 (8) ◽  
pp. e1202-e1214
Author(s):  
Julia R. Trosman ◽  
Christine B. Weldon ◽  
Bruce D. Rapkin ◽  
Al B. Benson ◽  
Della F. Makower ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Underserved Populations ◽  
Care Delivery ◽  
Safety Net ◽  
Self Management ◽  
Care Planning ◽  
Historical Cohort ◽  
Cancer Data ◽  
Manage Care ◽  
Flu Vaccination

PURPOSE: Optimal cancer care requires patient self-management and coordinated timing and sequence of interdependent care. These are challenging, especially in safety-net settings treating underserved populations. We evaluated the 4R Oncology model (4R) of patient-facing care planning for impact on self-management and delivery of interdependent care at safety-net and non–safety-net institutions. METHODS: Ten institutions (five safety-net and five non–safety-net) evaluated the 4R intervention from 2017 to 2020 with patients with stage 0-III breast cancer. Data on self-management and care delivery were collected via surveys and compared between the intervention cohort and the historical cohort (diagnosed before 4R launch). 4R usefulness was assessed within the intervention cohort. RESULTS: Survey response rate was 63% (422/670) in intervention and 47% (466/992) in historical cohort. 4R usefulness was reported by 79.9% of patients receiving 4R and was higher for patients in safety-net than in non–safety-net centers (87.6%, 74.2%, P = .001). The intervention cohort measured significantly higher than historical cohort in five of seven self-management metrics, including clarity of care timing and sequence (71.3%, 55%, P < .001) and ability to manage care (78.9%, 72.1%, P = .02). Referrals to interdependent care were significantly higher in the intervention than in the historical cohort along all six metrics, including primary care consult (33.9%, 27.7%, P = .045) and flu vaccination (38.6%, 27.9%, P = .001). Referral completions were significantly higher in four of six metrics. For safety-net patients, improvements in most self-management and care delivery metrics were similar or higher than for non–safety-net patients, even after controlling for all other variables. CONCLUSION: 4R Oncology was useful to patients and significantly improved self-management and delivery of interdependent care, but gaps remain. Model enhancements and further evaluations are needed for broad adoption. Patients in safety-net settings benefited from 4R at similar or higher rates than non–safety-net patients, indicating that 4R may reduce care disparities.

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]

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]

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]

Differences in breast cancer outcomes amongst Black United States-born and Caribbean-born immigrants.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1088-1088
Author(s):  
Priscila Barreto Coelho ◽  
Danielle Cerbon ◽  
Matthew Schlumbrecht ◽  
Carlos Parra ◽  
Judith Hurley ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Safety Net ◽  
Cancer Center ◽  
Advanced Stage ◽  
Cancer Data ◽  
Hispanic Caribbean ◽  
Safety Net Hospital ◽  
The Usa ◽  
The Caribbean

1088 Background: The Black population in the US constitutes of 4 million immigrants, with 50% from the Caribbean. It has been shown that breast cancer is responsible for 14%-30% of cancer deaths in the Caribbean; this is up to two times higher than the USA. Methods: Retrospective cohort of 1369 self-identified Black women with breast cancer. Data was obtained from Jackson Memorial Health Systems and University of Miami Health System Tumor Registry. Individual-level data from 1132 cases was used to estimate hazard rations (HRs) of women born in the Caribbean (CB) or in the USA (USB) using Cox proportional hazards regression analysis for overall survival. Median follow-up was 115 months (interquartile range, 91.9-138.1 months) per participant. Results: Data from 622 (54.9%) USB women and 507 (45%) CB women diagnosed with breast cancer between 2006-2017. 90% (n = 1232) of the cohort is of non-Hispanic ethnicity. Caribbean immigrants from Haiti (18.3%), Jamaica (6.5%), Bahamas (3.1%), Cuba and Dominica Republic (2.8% each), Trinidad and Tobago (1%) and other nationalities from the Organization of Eastern Caribbean States were included, mean age 55.7 [95% CI, 54.7-56.8]; USB mean age 57.6 [95% CI, 56.4-58.7] (P = 0.02). Compared to USB, CB had lower BMI at diagnosis 29.6 [95% CI, 28.9-30.3] versus 30.9 [95% CI, 30.1-31.7, P = 0.015]. Compared to CB patients, USB patients had more ER- [31.4% vs 39.1 %, P = 0.018] and triple negative breast cancers [19.6% vs 27.9%, P = 0.003]. Compared to USB patients, CB presented at more advanced stage, III and IV [44.2% vs 35.2%], p = 0.016. In spite of higher advanced stage at diagnoses, CB patients had a better breast cancer overall survival [HR = 0.75; 95%CI, 0.59-0.96; P = 0.024]. Black Hispanic patients had a better overall survival [HR = 0.51; 95%CI, 0.28-0.93; p = 0.028] compared to non-Hispanic Blacks. Compared to Hispanic Caribbean, non-Hispanic Caribbean had a worse overall survival [HR = 1.98; 95%CI, 1.00-3.94; P = 0.048]. The distribution of patients treated at the private cancer center and the safety net hospital were the same, differences in outcomes observed are due to intrinsic differences. Conclusions: This is the largest analysis to date of self-identified Black breast cancer patients in the context of nativity, race, ethnic identity and overall survival with clinico-pathologic characteristics. CB immigrants diagnosed with breast cancer have a better overall survival than US born Black patients. This finding suggests that within the African diaspora in the USA, additional factors beyond race contribute to the outcomes.

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]

Outsourcing Responsibility

2017 ◽  
Author(s):  
Cathleen E. Willging ◽  
Elise M. Trott
Keyword(s):  
Health Care ◽  
Low Income ◽  
Underserved Populations ◽  
Care Delivery ◽  
Health Care Systems ◽  
Behavioral Health Care ◽  
Safety Net ◽  
Treatment Needs ◽  
Health Care Safety Net ◽  
Care Systems

Cathleen E. Willging and Elise M. Trott argue that politically driven processes of the past have shaped the current context of mental health care delivery in New Mexico. Provisions of the ACA, including the expansion of Medicaid and outreach to underserved populations, offered the possibility of improving access and services for New Mexicans struggling with unmet treatment needs. However, as the authors argue, public stewards manipulated key ACA provisions to propagate unsubstantiated allegations of waste, fraud, and corruption against safety-net service providers. This chapter shows how public-private partnerships in the Medicaid arena, discourses of transparency, and technologies of accountability can engender truthiness claims, obscure vital information, destabilize a behavioral health care safety net, and deny low-income citizens care. They argue that scholars have the responsibility to attend to the “total bureaucratization” of government-funded health care systems that also allows such abuse of authority.

Results from a pilot of an innovative 4R Cancer Care Delivery Model in early breast cancer: Impact on timing and sequencing of guideline recommended care.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 281-281
Author(s):  
Christine B. Weldon ◽  
Julia Rachel Trosman ◽  
Claudia B. Perez ◽  
Swati Kulkarni ◽  
Seema Ahsan Khan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Neoadjuvant Therapy ◽  
Early Breast Cancer ◽  
Care Delivery ◽  
Safety Net ◽  
Academic Community ◽  
Community Safety ◽  
Control Cohort ◽  
Recommended Care ◽  
Genetic Test Results

281 Background: Under the “NCI ASCO Teams” Project, we proposed a 4R Model of teamwork and patient self-management (Trosman JOP ’16). 4R = Right Info / Care / Patient / Time. It enables patient and care team to manage timing / sequencing of interdependent care with an innovative multimodality personalized 4R Care Project Plan. We piloted 4R at 3 centers (academic, community, safety net) and assessed impact on timing / sequencing of guideline based care. Methods: 4R Plans were administered to breast cancer patients stage 0-III Sept ’17 – Aug ’17. Clinical data for 185 patients who received 4R (4R cohort) were compared with a historical control cohort of comparable patients who received care pre-4R, Jun ’16 – May ’17. We used simple frequencies and Fisher’s exact test in analyses. Results: We improved timing / sequencing of 7 guideline recommended metrics (Table). Significant improvements were shown for care lacking in the control cohort. 4R improved rate of patients receiving genetic test results and fertility in a timely manner. Neoadjuvant therapy rate doubled, but low sample size precluded statistical conclusions. However, timing / sequencing of care needed prior to neoadjuvant therapy (eg fertility, flu shot) were significantly improved. Conclusions: The 4R model significantly improved timing / sequencing of guideline recommended care in early breast cancer. An ongoing 4R pilot at 12 additional cancer centers across the U.S. is continuing to accrue patients and focusing on other guideline-recommended metrics. [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]

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 (27_suppl) ◽  
pp. 36-36
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

36 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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