Evaluating the patient-centered quality of cancer survivorship care models

Publication Year:
2017
Usage 25
Abstract Views 25
Repository URL:
https://hsrc.himmelfarb.gwu.edu/gw_research_days/2017/GWSPH/25
Author(s):
Gianattasio, Kan; Mead, Holly; Seyoum, Semret; Raskin, Sarah; Pratt-Chapman, Mandi
Tags:
Cancer survivorship; Models of care; Patient-centered outcomes
poster description
OBJECTIVE: The growing population of cancer survivors (15.5 million in the US) face myriad physical and psychosocial health issues even after treatment has ended. Because of this, cancer is increasingly viewed as a chronic condition that requires systematic and coordinated care. Cancer centers have begun providing survivorship care; however, efforts are varied and scattered given the lack of evidence-based guidance on how care should be organized to most effectively provide high quality, patient-centered care. This study aims to evaluate the impact of three emerging models of cancer survivorship care on a newly developed patient-centered measure of quality care.METHODS: We conducted a comparative effectiveness research (CER) study with 32 high-performing survivorship programs distributed across three models of survivorship care to examine the quality of care provided to survivors of breast, prostate and colorectal cancer. A total of 991 cancer survivors across the 32 institutions were recruited and followed for six months. We collected self-reported data on the quality of care provided during survivorship services using the Patient-Prioritized Measure of High Quality Survivorship Care (PPM) containing 46 individual metrics categorized into nine domains of care. GLM and Pearson chi-square tests of independence were conducted to determine whether and which models had statistically significantly different scores across the domains and individual metrics.RESULTS: The emerging models of survivorship care identified are: 1) Specialized consultative model, 2) Specialized longitudinal model, and 3) Oncology-Embedded model. Preliminary quality results from patients’ first survivorship visit suggest that the embedded model performs lower than the specialized models in eight of the nine PPM domains (plt;0.05), including: care coordination, patient-provider engagement, and provision of a full spectrum of survivorship-related services and resources. Between the two specialized models, differences in mean domain scores is significant for just one domain (with model 2 performing better in providing a medical home, plt;0.05); however, differences are significant for several of the individual metrics. For example, clinicians in model 2 are more likely to review patients’ medications, which is a metric contained within the care coordination domain.CONCLUSIONS: It appears that certain models of survivorship care are better at providing specific aspects of patient-centered quality of care, suggesting cancer centers should consider their patients’ needs before committing to a particular model of care. The next step of this research is to examine whether differences in the quality and patient-centeredness of care is associated with differences in quality of life and patient self-efficacy outcomes.METHODS: We conducted a comparative effectiveness research (CER) study with 32 high-performing survivorship programs distributed across three models of survivorship care to examine the quality of care provided to survivors of breast, prostate and colorectal cancer. A total of 991 cancer survivors across the 32 institutions were recruited and followed for six months. We collected self-reported data on the quality of care provided during survivorship services using the Patient-Prioritized Measure of High Quality Survivorship Care (PPM) containing 46 individual metrics categorized into nine domains of care. GLM and Pearson chi-square tests of independence were conducted to determine whether and which models had statistically significantly different scores across the domains and individual metrics.RESULTS: The emerging models of survivorship care identified are: 1) Specialized consultative model, 2) Specialized longitudinal model, and 3) Oncology-Embedded model. Preliminary quality results from patients’ first survivorship visit suggest that the embedded model performs lower than the specialized models in eight of the nine PPM domains (plt;0.05), including: care coordination, patient-provider engagement, and provision of a full spectrum of survivorship-related services and resources. Between the two specialized models, differences in mean domain scores is significant for just one domain (with model 2 performing better in providing a medical home, plt;0.05); however, differences are significant for several of the individual metrics. For example, clinicians in model 2 are more likely to review patients’ medications, which is a metric contained within the care coordination domain.CONCLUSIONS: It appears that certain models of survivorship care are better at providing specific aspects of patient-centered quality of care, suggesting cancer centers should consider their patients' needs before committing to a particular model of care. The next step of this research is to examine whether differences in the quality and patient-centeredness of care is associated with differences in quality of life and patient self-efficacy outcomes.