Care coordination for complex cancer survivors in an integrated safety-net system: A study protocol 11 Medical and Health Sciences 1117 Public Health and Health Services 11 Medical and Health Sciences 1110 Nursing

Simon J.Craddock Lee, Katelyn K. Jetelina, Emily Marks, Eric Shaw, Kevin Oeffinger, Deborah Cohen, Noel O. Santini, John V. Cox, Bijal A. Balasubramanian

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article number1204
JournalBMC cancer
Volume18
Issue number1
DOIs
StatePublished - Dec 4 2018

Keywords

  • Cancer survivorship care
  • Care coordination
  • Oncology
  • Primary care

ASJC Scopus subject areas

  • Genetics
  • Oncology
  • Cancer Research

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