scholarly journals Think Globally, Start Locally: Value-Based Breast Cancer Care for Newly Diagnosed Patients in A Safety-Net Medical Center

2022 ◽  
Author(s):  
Shannon R Ugarte ◽  
Amal L Khoury ◽  
Bishal Gyawali ◽  
Anna Chiang ◽  
Nicole Lai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Medical Center ◽  
Safety Net ◽  
Newly Diagnosed ◽  
Breast Cancer Care

Evaluation of Patterns in Access to Breast Cancer Care and Breast Cancer Presentation in a Safety Net Patient Population

2021 ◽  
pp. 000313482096628
Author(s):  
Erica Choe ◽  
Hayoung Park ◽  
Ma’at Hembrick ◽  
Christine Dauphine ◽  
Junko Ozao-Choy
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Cancer Care ◽  
Patient Population ◽  
Safety Net ◽  
Minority Women ◽  
Breast Cancer Care ◽  
Safety Net Hospital ◽  
Screening Mammograms

Background While prior studies have shown the apparent health disparities in breast cancer diagnosis and treatment, there is a gap in knowledge with respect to access to breast cancer care among minority women. Methods We performed a retrospective analysis of patients with newly diagnosed breast cancer from 2014 to 2016 to evaluate how patients presented and accessed cancer care services in our urban safety net hospital. Patient demographics, cancer stage, history of breast cancer screening, and process of referral to cancer care were collected and analyzed. Results Of the 202 patients identified, 61 (30%) patients were younger than the age of 50 and 75 (63%) were of racial minority background. Only 39% of patients with a new breast cancer were diagnosed on screening mammogram. Women younger than the age of 50 ( P < .001) and minority women ( P < .001) were significantly less likely to have had any prior screening mammograms. Furthermore, in patients who met the screening guideline age, more than half did not have prior screening mammograms. Discussion Future research should explore how to improve breast cancer screening rates within our county patient population and the potential need for revision of screening guidelines for minority patients.

An Analysis of Electronic Health Record Work to Manage Asynchronous Clinical Messages among Breast Cancer Care Teams

2021 ◽  
Vol 12 (04) ◽  
pp. 877-887
Author(s):  
Bryan D. Steitz ◽  
Kim M. Unertl ◽  
Mia A. Levy
Keyword(s):  
Breast Cancer ◽  
Electronic Health Record ◽  
Cancer Care ◽  
Medical Center ◽  
Asynchronous Communication ◽  
Care Team ◽  
Health Record ◽  
Breast Cancer Care ◽  
Team Members ◽  
Electronic Health

Abstract Objective Asynchronous messaging is an integral aspect of communication in clinical settings, but imposes additional work and potentially leads to inefficiency. The goal of this study was to describe the time spent using the electronic health record (EHR) to manage asynchronous communication to support breast cancer care coordination. Methods We analyzed 3 years of audit logs and secure messaging logs from the EHR for care team members involved in breast cancer care at Vanderbilt University Medical Center. To evaluate trends in EHR use, we combined log data into sequences of events that occurred within 15 minutes of any other event by the same employee about the same patient. Results Our cohort of 9,761 patients were the subject of 430,857 message threads by 7,194 employees over a 3-year period. Breast cancer care team members performed messaging actions in 37.5% of all EHR sessions, averaging 29.8 (standard deviation [SD] = 23.5) messaging sessions per day. Messaging sessions lasted an average of 1.1 (95% confidence interval: 0.99–1.24) minutes longer than nonmessaging sessions. On days when the cancer providers did not otherwise have clinical responsibilities, they still performed messaging actions in an average of 15 (SD = 11.9) sessions per day. Conclusion At our institution, clinical messaging occurred in 35% of all EHR sessions. Clinical messaging, sometimes viewed as a supporting task of clinical work, is important to delivering and coordinating care across roles. Measuring the electronic work of asynchronous communication among care team members affords the opportunity to systematically identify opportunities to improve employee workload.

scholarly journals Challenges in the Delivery of Quality Breast Cancer Care: Initiation of Adjuvant Hormone Therapy at an Urban Safety Net Hospital

2014 ◽  
Vol 10 (2) ◽  
pp. e107-e112 ◽  
Author(s):  
Meaghan M. Crowley ◽  
Molly E. McCoy ◽  
Sharon M. Bak ◽  
Sarah E. Caron ◽  
Naomi Y. Ko ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Hormone Therapy ◽  
Cancer Care ◽  
Safety Net ◽  
Breast Cancer Treatment ◽  
Breast Cancer Care ◽  
Adjuvant Hormone Therapy ◽  
Safety Net Hospital ◽  
Urban Safety

Urgently needed interventions to reduce disparities in breast cancer treatment should take into account obstacles inherent among immigrant and indigent populations and complexities of multidisciplinary cancer care.

Overcoming Disparities: Multidisciplinary Breast Cancer Care at a Public Safety-Net Hospital

2019 ◽  
Vol 229 (4) ◽  
pp. S159
Author(s):  
Kristin N. Kelly ◽  
Emily Ryon ◽  
Ahkeel Allen ◽  
Dido Franceschi ◽  
Mecker Moller ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Public Safety ◽  
Safety Net ◽  
Breast Cancer Care ◽  
Safety Net Hospital

Does the innovative 4R Care Delivery Model improve timing and sequencing of guideline recommended breast cancer care in safety net and non-safety net centers?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 562-562
Author(s):  
Christine B. Weldon ◽  
Julia Rachel Trosman ◽  
Della F. Makower ◽  
Bruce D. Rapkin ◽  
Moreen Bozier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Care Delivery ◽  
Safety Net ◽  
Similar Rate ◽  
Care Patient ◽  
Control Cohort ◽  
Breast Cancer Care ◽  
Recommended Care ◽  
Reported Data

562 Background: Under the NCI ASCO Teams Project, we proposed a 4R Model which enables patient (pt) and care team to manage timing and sequencing of interdependent care with a novel multimodality 4R Care Project Plan (Trosman JOP ’16). 4R (Right Info/Care/Patient/Time) was previously piloted at 3 Chicago centers (Weldon ASCO ‘18). Methods: A new study tested impact of 4R on timing and sequencing of guideline recommended care at 4 safety net and 3 non safety net US centers. 4R Plans were provided to stage 0-III breast cancer pts Jan-Nov’18, 4R cohort. Clinical and pt reported data analyses compared 4R cohort (N=105) to a historical control cohort of pts who received care pre-4R, Jan - Dec ’17 (N=190). Results: We significantly improved 3 referral metrics and 4 referral completion metrics - receipt of care by pts who were referred (Table). After referrals, safety net pts had a significant increase in 4R vs control cohort in receiving genetic consult (72%, 21/29 vs. 42%, 18/43, p=.02) and dental visit (100%, 6/6 vs. 20%, 1/5, p=.02). They had lower increases in flu shot referrals (41%, 24/58, vs 36%, 37/104, NS) and dental referrals (10%, 6/58, vs 5%, 5/104, NS) than non safety net pts who had significant increases. Other metrics improved at a similar rate for safety net and non safety net pts. Conclusions: 4R markedly improved referral and receipt of interdependent guideline recommended breast cancer care. For most metrics safety net pts benefited from 4R at a similar or higher rate than non safety net pts, indicating that 4R may reduce care disparities. Low increases in referrals for safety net pts and in trial referral/enrollment for all pts must be addressed. An expansion of 4R across the US continues this work. [Table: see text]

Does the innovative 4R Care Delivery Model improve timing and sequencing of guideline recommended breast cancer care in safety net and non-safety net centers?

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 36-36
Author(s):  
Christine B. Weldon ◽  
Julia Rachel Trosman ◽  
Della F. Makower ◽  
Bruce D. Rapkin ◽  
Moreen Bozier ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Care Delivery ◽  
Safety Net ◽  
Similar Rate ◽  
Care Patient ◽  
Control Cohort ◽  
Breast Cancer Care ◽  
Recommended Care ◽  
Reported Data

36 Background: Under the NCI ASCO Teams Project, we proposed a 4R Model which enables patient (pt) and care team to manage timing and sequencing of interdependent care with a novel multimodality 4R Care Project Plan (Trosman JOP ’16). 4R (Right Info/Care/Patient/Time) was previously piloted at 3 Chicago centers (Weldon ASCO ‘18). Methods: A new study tested impact of 4R on timing and sequencing of guideline recommended care at 4 safety net and 3 non safety net US centers. 4R Plans were provided to stage 0-III breast cancer pts Jan - Nov’18, 4R cohort. Clinical and pt reported data analyses compared 4R cohort (N = 105) to a historical control cohort of pts who received care pre-4R, Jan - Dec ’17 (N = 190). Results: We significantly improved 3 referral metrics and 4 referral completion metrics - receipt of care by pts who were referred (Table). After referrals, safety net pts had a significant increase in 4R vs control cohort in receiving genetic consult (72%, 21/29 vs. 42%, 18/43, p = .02) and dental visit (100%, 6/6 vs. 20%, 1/5, p = .02). They had lower increases in flu shot referrals (41%, 24/58, vs 36%, 37/104, NS) and dental referrals (10%, 6/58, vs 5%, 5/104, NS) than non safety net pts who had significant increases. Other metrics improved at a similar rate for safety net and non safety net pts. Conclusions: 4R markedly improved referral and receipt of interdependent guideline recommended breast cancer care. For most metrics safety net pts benefited from 4R at a similar or higher rate than non safety net pts, indicating that 4R may reduce care disparities. Low increases in referrals for safety net pts and in trial referral/enrollment for all pts must be addressed. An expansion of 4R across the US continues this work. [Table: see text]

scholarly journals The Challenge of Improving Breast Cancer Care Coordination in Safety-net Hospitals

Medical Care ◽  
2016 ◽  
Vol 54 (2) ◽  
pp. 147-154 ◽  
Author(s):  
Ann Scheck McAlearney ◽  
Kelsey Murray ◽  
Cynthia Sieck ◽  
Jenny J. Lin ◽  
Bonnie Bellacera ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Care Coordination ◽  
Cancer Care ◽  
Safety Net ◽  
Breast Cancer Care

Effect of a new model for multidisciplinary breast cancer care on clinical metrics leading to efficiency and timeliness of access.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 107-107
Author(s):  
Rashmi Krishna Murthy ◽  
Susan E Ferguson ◽  
Welela Tereffe ◽  
Isabelle Bedrosian ◽  
Stacy L. Moulder
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Cancer Center ◽  
Newly Diagnosed ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
University Of Texas ◽  
Breast Center ◽  
Receive Treatment ◽  
Md Anderson

107 Background: The multidisciplinary approach to breast cancer care provides a coordinated mechanism for evaluating and treating new patients. Improving the structure of clinic models may further enhance the delivery of cancer care. Methods: In May 2013, multi-team (MT) clinics were introduced in the breast center at the University of Texas MD Anderson Cancer Center. Local patients with newly diagnosed breast cancer were scheduled to be seen in a MT clinic with testing coordinated for the same day. Patient cases were first reviewed and examined concurrently by physicians from each discipline (surgical, medical, radiation), followed by sequential visits with each clinician for a more detailed discussion. The goal of this program was to determine whether a highly integrated multidisciplinary clinic model would improve the efficient delivery of cancer treatment. Results: From 5/2013 – 5/2014, 211 newly diagnosed and untreated breast cancer patients were seen in the MT clinic. Clinical metrics were reviewed retrospectively and compared to newly diagnosed and untreated patients who entered the clinic using the standard model (non-MT patients) (n=1944). Please see Table for details of the data. Conclusions: Multi-team clinics improved clinical metrics leading to efficiency and timeliness of access. The model enriched for a population of patients who were more likely to receive treatment within the breast center, utilize institutional resources, and enroll into clinical trials. [Table: see text]

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