ASO Visual Abstract: Integrating a Disease-Focused Tumor Board as a Delivery-of-Care Model to Expedite Treatment Initiation for Patients with Liver Malignancies

ZusammenfassungThese guidelines aim to support medical personnel and physicians working in oncology in selecting appropriate patients, in treatment planning, preparation and implementation of SIRT for the treatment of primary and secondary liver malignancies. The focus lies on the requirements in the treatment center with regard to staffing, technical, and organizational aspects including radiation safety. Patient selection need to be performed in an interdisciplinary tumor board including the medical team tasked with the treatment and a medical physics expert. The aims of the treatment, the workup necessary for patient selection and treatment planning, and for avoiding complications are presented as are the requirements for obtaining informed consent from the patient. The follow-up of patients after SIRT also requires interdisciplinary cooperation, including communication with the local family physician.

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Risk of Coronary Artery Disease in Type 2 Diabetes and the Delivery of Care Consistent With the Chronic Care Model in Primary Care Settings

Medical Care ◽

10.1097/mlr.0b013e318148431e ◽

2007 ◽

Vol 45 (12) ◽

pp. 1129-1134 ◽

Cited By ~ 43

Author(s):

Michael L. Parchman ◽

John E. Zeber ◽

Raquel R. Romero ◽

Jacqueline A. Pugh

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Coronary Artery Disease ◽

Chronic Care Model ◽

Chronic Care ◽

Care Model ◽

Delivery Of Care ◽

Primary Care Settings ◽

Artery Disease

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A Multisite Randomized Block Experiment on the Seamless System of Care Model for Drug-Involved Probationers

Journal of Drug Issues ◽

10.1177/0022042616678606 ◽

2016 ◽

Vol 47 (1) ◽

pp. 50-73 ◽

Cited By ~ 3

Author(s):

Alese Wooditch ◽

Lincoln B. Sloas ◽

Faye S. Taxman

Keyword(s):

Treatment Initiation ◽

System Of Care ◽

Community Treatment ◽

Risk Level ◽

Care Group ◽

Control Group ◽

Care Model ◽

Probation Office ◽

Abuse Treatment ◽

Block Experiment

This multisite randomized block experiment examines the efficacy of the seamless system of care for probationers (an integrated probation model combined with substance abuse treatment intervention onsite at a probation office). The sample consists of 251 drug-involved probationers randomized into probation with referral to community treatment or the seamless system of care. Key outcomes are examined over a 1-year period by recidivism risk level. When compared with probationers in the control group, the findings are that those in the seamless system of care group had fewer drug use days overall, less alcohol consumption, improved treatment initiation and adherence, but a higher number of days incarcerated. Low-risk seamless system participants had the most favorable outcomes compared with other study conditions. This study demonstrates the importance of tailoring interventions to the risk level of the probationer, and that the seamless system works better for lower risk offenders with substance use disorders.

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On-site testing and case management to improve hepatitis C care in drug users: a prospective, longitudinal, multicenter study in the DAA era

BMC Public Health ◽

10.1186/s12889-021-11608-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dana Busschots ◽

Rob Bielen ◽

Özgür M. Koc ◽

Leen Heyens ◽

Eefje Dercon ◽

...

Keyword(s):

Hepatitis C ◽

Case Management ◽

Multicenter Study ◽

Treatment Initiation ◽

Care Center ◽

Linkage To Care ◽

Hcv Infection ◽

Care Model ◽

Care Cascade ◽

Addiction Care

Abstract Background Screening and treatment of hepatitis C virus (HCV) infection in people who use drugs (PWUD) remains insufficient. Reducing the burden of HCV infection in PWUD requires interventions focusing on the different steps of the HCV care cascade. Methods We performed a prospective, multicenter study, evaluating the impact of an HCV care model on the HCV care cascade among PWUD attending an addiction care center in Belgium between 2015 and 2018. Interventions within the care model consisted of pre-test counseling, on-site HCV screening and case management services. A multiple logistic regression model was performed to identify the independent factors influencing the outcomes. Results During the study period, 441 PWUD were registered at the addiction care center, 90% (395/441) were contacted, 88% (349/395) were screened for HCV infection. PWUD were more likely to be screened if they had ever injected drugs (p < .001; AOR 6.411 95% CI 3.464–11.864). In 45% (157/349), the HCV antibody (Ab) test was positive, and in 27% (94/349) HCV RNA was positive. Within the Belgian reimbursement criteria (fibrosis stage ≥ F2), 44% (41/94) were treated. Specialist evaluation at the hospital was lower for PWUD receiving decentralized opioid agonist therapy (p = .005; AOR 0.430 95% CI 0.005–0.380), PWUD with unstable housing in the past 6 months before inclusion (p = .015; AOR 0.035 95% CI 0.002–0.517) or if they were recently incarcerated (p = .001; AOR 0.010 95% CI 0.001–0.164). Conclusions This HCV care model demonstrated high screening, linkage to care, and treatment initiation among PWUD in Belgium. Using the cascade of care to guide interventions is easy and necessary to monitor results. This population needs guidance, not only for screening and treatment initiation but also for the long-term follow-up since one in six had cirrhosis and could develop hepatocellular carcinoma. Further interventions are necessary to increase linkage to care and treatment initiation. Universal access to direct-acting antiviral therapy from 2019 will contribute to achieving HCV elimination in the PWUD population. Trial registration Clinical trial registration details: www.clinicaltrials.gov (NCT03106194).

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Workup of Suspected Chest Metastases on 18F-FDG-PET/CT in Head and Neck Cancer: Worth the Wait?

Ear Nose & Throat Journal ◽

10.1177/0145561319828315 ◽

2019 ◽

Vol 98 (3) ◽

pp. 158-164 ◽

Cited By ~ 1

Author(s):

Christopher J. Leto ◽

Daniel Sharbel ◽

Chien Wei Wang ◽

Tyler M. Bone ◽

Robert M. Liebman ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Treatment Initiation ◽

Treatment Plan ◽

Primary Treatment ◽

Tumor Board ◽

Ct Findings ◽

Pet Ct ◽

The Impact

The objective of our study is to assess the impact of equivocal or positive positron emission tomography combined with low-dose noncontrast computed tomography (PET/CT) findings in the chest on treatment for head and neck cancer (HNC). We reviewed charts of patients presented at Augusta University’s Head and Neck Tumor Board (AUTB) between 2013 and 2016 with the following exclusion criteria: <18 years, Veterans Affairs patients, those with incomplete data, and those without a history of head and neck squamous cell carcinoma. The lung/thorax sections of the radiologists’ PET/CT reports were graded as “Positive, Equivocal, or Negative” for chest metastases. Patients who underwent workup for suspected chest metastases were assessed for treatment delays, changes in treatment plans, and complications. In addition, we evaluated the time between AUTB presentation and peri-treatment PET/CT to primary treatment initiation were calculated between groups. There was a total of 363 patients with PET/CT prior to treatment, the read was “Negative” in 71.3% (n = 259), “Equivocal” in 20.9% (n = 76), and “Positive” in 5.8% (n = 21). Of 272 patients with complete treatment data, 22 underwent workup for suspected chest metastases. Mean time from PET/CT to treatment initiation was 27.5 days without workup and 64.9 days with workup ( P < .0001), and from AUTB presentation was 29.1 days without workup and 62.5 days with workup ( P < .0001). Five (19.2%) patients experienced a complication from workup. Twenty (76.9%) patients had no changes in their treatment plan after workup. In conclusion, our results for potential chest metastases on PET/CT in patients with HNC are often not clear-cut. Workup of suspected chest metastasis based on PET/CT findings significantly delays primary treatment initiation and may cause serious complications.

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Social Determinants of Health, the Chronic Care Model, and Systemic Lupus Erythematosus

International Journal of Chronic Diseases ◽

10.1155/2014/361792 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7

Author(s):

Edith M. Williams ◽

Kasim Ortiz ◽

Teri Browne

Keyword(s):

Systemic Lupus Erythematosus ◽

Social Determinants Of Health ◽

Social Determinants ◽

Lupus Erythematosus ◽

Chronic Care Model ◽

Chronic Care ◽

Determinants Of Health ◽

Care Model ◽

Systemic Lupus ◽

Delivery Of Care

Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that disproportionately affects African Americans and other minorities in the USA. Public health attention to SLE has been predominantly epidemiological. To better understand the effects of this cumulative disadvantage and ultimately improve the delivery of care, specifically in the context of SLE, we propose that more research attention to the social determinants of SLE is warranted and more transdisciplinary approaches are necessary to appropriately address identified social determinants of SLE. Further, we suggest drawing from the chronic care model (CCM) for an understanding of how community-level factors may exacerbate disparities explored within social determinant frameworks or facilitate better delivery of care for SLE patients. Grounded in social determinants of health (SDH) frameworks and the CCM, this paper presents issues relative to accessibility to suggest that more transdisciplinary research focused on the role of place could improve care for SLE patients, particularly the most vulnerable patients. It is our hope that this paper will serve as a springboard for future studies to more effectively connect social determinants of health with the chronic care model and thus more comprehensively address adverse health trajectories in SLE and other chronic conditions.

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Predictors of Medication-Assisted Treatment Initiation for Opioid Use Disorder in an Interdisciplinary Primary Care Model

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2019.05.190012 ◽

2019 ◽

Vol 32 (5) ◽

pp. 724-731 ◽

Cited By ~ 4

Author(s):

Rebecca E. Cantone ◽

Brian Garvey ◽

Allison O'Neill ◽

Joan Fleishman ◽

Deborah Cohen ◽

...

Keyword(s):

Primary Care ◽

Treatment Initiation ◽

Opioid Use Disorder ◽

Opioid Use ◽

Care Model ◽

Medication Assisted Treatment ◽

Primary Care Model

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Models of Care for Chronic Pain

Canadian Journal of Health Technologies ◽

10.51731/cjht.2021.78 ◽

2021 ◽

Vol 1 (6) ◽

Author(s):

Kendra Brett ◽

Danielle MacDougall

Keyword(s):

Health Care ◽

Chronic Pain ◽

Models Of Care ◽

Stepped Care ◽

Care Utilization ◽

Care Model ◽

Hub And Spoke ◽

Delivery Of Care ◽

Care Models ◽

Oncology Care

For chronic pain, 1 hub-and-spoke model and 4 stepped care models for the delivery of care in Canada and internationally were identified and described. No information was found on the use of the Oncology Care Model for chronic pain. For other medical conditions, 9 stepped care models, 5 hub-and-spoke models, and the Oncology Care Model for the delivery of care in Canada and internationally were identified and described. Patient-related outcomes used to evaluate the effectiveness of models of care for chronic pain include pain measures (e.g., intensity, duration), psychosocial outcomes (e.g., anxiety, depression), functional outcomes (e.g., disability, employment status), and health care utilization (e.g., opioid prescriptions, health care visits). Various barriers and facilitators to providing care for patients with chronic pain were identified in the consultations and the literature. The most common factors that influenced the care provided to patients with chronic pain pertained to funding, support, and collaboration from the government and locally; having a centralized intake and referral system; and leveraging existing resources. There appears to be considerable variation in the models of care used to address the care needs of patients with chronic pain. In Canada, there are provincial, regional, and local models, and local programs; some regions do not have a formalized approach for the provision of care for chronic pain patients.

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