Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
Karen Kinahan , Sheetal Mehta Kircher , Jessica K. Altman , Alfred Rademaker , John M Salsman , Aarati Didwania , Stacy D. Sanford
Background: The “Shared-Care Model” involves care coordination between primary care providers (PCPs) and oncologists with aims of optimizing survivorship care. Adolescent and young adult (AYA) survivors may live decades post-diagnosis and are at risk for late effects, however, a high proportion of these patients do not have a PCP. Study objectives were to promote this model by 1) increasing the percentage of AYA with a PCP documented in the electronic medical record (EMR) via the use of a Best Practice Advisory (BPA) or “stopgap” intervention; 2) increase communication between providers by the number of clinic notes routed to providers; and 3) assess oncology providers’ attitudes/beliefs about the model and intervention. Methods: Data were collected for the 6 months prior to implementation of the BPA to determine percent of AYA with a PCP and number of notes routed to providers (T1, time point 1). The same data were collected at time point 2 (T2) after the BPA had been implemented for 6 months. Oncology providers participated in an education video module and an on-line survey at T1 and survey at T2. Results: During T1, 756 AYAs (18-39) were reviewed. 41% did not have a documented PCP in the EMR. After implementation of the BPA at T2, the percentage of patients without a PCP decreased to 31%, p < 0.0001 by Fisher’s exact test. The number of routed notes did not change significantly from T1 (38.7%) to T2 (40.6%) (p = 0.15). Of 61 eligible oncology providers, 70% completed the intervention survey at T1 and 65% at T2. Providers agreed/strongly agreed that the shared-care model is a desirable model of care (T1 = 86%; T2 = 93%); that PCPs have the skills necessary to provide cancer-related follow up care; (T1 = 51%; T2 = 46%); and that a BPA is useful for facilitating PCP referrals (T1 = 76%; T2 = 39%). Conclusions: This BPA is feasible and could potentially lead to increased PCP referral and communication for the benefit of long-term survivorship care in the AYA population.
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