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Surveillance for colorectal cancer survivors in an integrated safety-net health system in the United States.

ABSTRACT: Introduction:Guideline-recommended surveillance reduces likelihood of colorectal cancer (CRC) recurrence, yet surveillance rates are low in the United States (US). Little is known about CRC surveillance rates among patients without health insurance and their primary care clinicians/oncologists' attitudes towards surveillance care. Methods:A retrospective study of 205 patients diagnosed with Stage I-III CRC from 2008-2010 was conducted in an integrated system with a network of providers delivering care to patients lacking health insurance coverage. Surveillance patterns were characterized from medical records and logistic regression models examined correlates of guideline-concordant surveillance. 41 Parkland primary care physicians (PCPs) and 24 oncologists completed surveys to assess their attitudes and practices regarding CRC surveillance. Results:38% of CRC patients received guideline-concordant surveillance; those with early stage cancers were less likely to receive surveillance (OR=0.35; 95 CI: 0.14, 0.87). PCPs and oncologists differed markedly on who is responsible for cancer surveillance care. 77% of oncologists responded that PCPs evaluated patients for cancer recurrence while 76% of PCPs responded that these services were either ordered by oncologists or shared with PCPs. 67% of oncologists said they rarely provide a treatment and surveillance care plan to survivors and over half said that they infrequently communicate with patients' other physicians about who will follow patients for their cancer and other medical issues. Discussion:Care coordination between PCP and oncologist is needed to improve CRC surveillance. New models of shared care clearly delineating roles for oncologists and PCPs are needed to improve CRC survivorship care.

SUBMITTER: Balasubramanian BA

PROVIDER: S-EPMC6197490 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Surveillance for colorectal cancer survivors in an integrated safety-net health system in the United States.

Balasubramanian Bijal A BA Jetelina Katelyn K KK Bowen Michael M Santini Noel O NO Lee Simon Craddock SC

International journal of care coordination 20180601 1-2

<h4>Introduction</h4>Guideline-recommended surveillance reduces likelihood of colorectal cancer (CRC) recurrence, yet surveillance rates are low in the United States (US). Little is known about CRC surveillance rates among patients without health insurance and their primary care clinicians/oncologists' attitudes towards surveillance care.<h4>Methods</h4>A retrospective study of 205 patients diagnosed with Stage I-III CRC from 2008-2010 was conducted in an integrated system with a network of prov ...[more]

PMID: 30364563

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Project description:BACKGROUND:The growing numbers of cancer survivors challenge delivery of high-quality survivorship care by healthcare systems. Innovative ways to improve care coordination for patients with cancer and multiple chronic conditions ("complex cancer survivors") are needed to achieve better care outcomes, improve patient experience of care, and lower cost. Our study, Project CONNECT, will adapt and implement three evidence-based care coordination strategies, shown to be effective for primary care conditions, among complex cancer survivors. Specifically, the purpose of this study is to: 1) Implement a system-level EHR-driven intervention for 500 complex cancer survivors at Parkland; 2) Test effectiveness of the strategies on system- and patient-level outcomes measured before and after implementation; and 3) Elucidate system and patient factors that facilitate or hinder implementation and result in differences in experiences of care coordination between complex patients with and without cancer. METHODS:Project CONNECT is a quasi-experimental implementation study among 500 breast and colorectal cancer survivors with at least one of the following chronic conditions: diabetes, hypertension, chronic lung disease, chronic kidney disease, or heart disease. We will implement three evidence-based care coordination strategies in a large, county integrated safety-net health system: 1) an EHR-driven registry to facilitate patient transitions between primary and oncology care; 2) co-locating a nurse practitioner trained in care coordination within a complex care team; 3) and enhancing teamwork through coaching. Segmented regression analysis will evaluate change in system-level (i.e. composite care quality score) and patient-level outcomes (i.e. self-reported care coordination). To evaluate implementation, we will merge quantitative findings with structured observations and physician and patient interviews. DISCUSSION:This study will result in an evaluation toolkit identifying key model elements, barriers, and facilitators that can be used to guide care coordination interventions in other safety-net settings. Because Parkland is a vanguard of safety-net healthcare nationally, findings will be widely applicable as other safety-nets move toward increased integration, enhanced EHR capability, and experience with growing patient diversity. Our proposal recognizes the complexity of interventions and scaffolds evidence-based strategies together to meet the needs of complex patients, systems of care, and service integration. TRIAL REGISTRATION:ClinicalTrials.gov, NCT02943265 . Registered 24 October 2016.

Dataset Information

Surveillance for colorectal cancer survivors in an integrated safety-net health system in the United States.

Publications

Surveillance for colorectal cancer survivors in an integrated safety-net health system in the United States.

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