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Acute home-based care for patients with cancer to avoid, substitute, and follow emergency department visits: a conceptual framework using Porter’s Five Forces. EMERGENCY CANCER CARE 2022; 1:8. [PMID: 35844665 PMCID: PMC9247981 DOI: 10.1186/s44201-022-00008-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/08/2022] [Indexed: 12/04/2022]
Abstract
Background Patients with cancer constitute a large and increasing segment of patients who receive unscheduled hospital-based care due to treatment-related symptoms and disease progression. The initial hospital-based touchpoint for these unscheduled hospitalizations is often the emergency department. Traditional models of emergency department and inpatient hospital-based care are saturated and incapable of scaling to accommodate the future, increased needs projected for this population. New models of care are necessary to address this gap. Acute home-based care is a promising tool potentially providing patient-centric, efficient care to eligible patients. Methods We applied Porter’s Five Forces framework that addresses the bargaining power of buyers and suppliers, threat of substitutes and new entrants, and industry rivalries plus the sixth force of regulation to clarify the factors that will promote or challenge the adoption of a home-based cancer care referral model before or following emergency department visits. Exploring this framework provides insights into the complexities of scaling an acute home-based cancer care model and highlights ways for health systems including hospitals, emergency departments, physician groups, and individual emergency physicians and oncologists to optimize their roles in this emerging model of care. Results We found that current workforce shortages, as well as workflow, infrastructure, and regulatory complexities, pose major challenges that unless carefully addressed may restrict the growth of acute home-based cancer care. Additional uncertainties persist around appropriate payment models and the competitive landscape. Key promoting factors include the recognized need in the cancer community and among payers for new models to decrease unscheduled hospitalizations and emergency department visits as well as the uptake of home-based and technology-enabled solutions during the COVID-19 pandemic. A better understanding of these forces helps to clarify the risks and opportunities as new entrants build their programs. Conclusions Acute home-based cancer care is a promising tool to complement traditional outpatient clinics, emergency departments, and inpatient hospital-based models of cancer care. New technologies and policies increasingly enable a broader scope of cancer care in the home setting.
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Bourbeau BR, Hagerty K, Dickson N, Polite B, Chasky M, Grubbs S. Practice Considerations for Participation in the Enhancing Oncology Model. JCO Oncol Pract 2022; 18:737-741. [PMID: 36252157 DOI: 10.1200/op.22.00508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - Karen Hagerty
- American Society of Clinical Oncology, Alexandria, VA
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Woofter K, Kennedy EB, Adelson K, Bowman R, Brodie R, Dickson N, Gerber R, Fields KK, Murtaugh C, Polite B, Paschall M, Skelton M, Zoet D, Cox JV. Oncology Medical Home: ASCO and COA Standards. JCO Oncol Pract 2021; 17:475-492. [PMID: 34255551 DOI: 10.1200/op.21.00167] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide Standards on the basis of evidence and expert consensus for a pilot of the Oncology Medical Home (OMH) certification program. The OMH model is a system of care delivery that features coordinated, efficient, accessible, and evidence-based care and includes a process for measurement of outcomes to facilitate continuous quality improvement. The OMH pilot is intended to inform further refinement of Standards for OMH model implementation. METHODS An Expert Panel was formed, and a systematic review of the literature on the topics of OMH, clinical pathways, and survivorship care plans was performed using PubMed and Google Scholar. Using this evidence base and an informal consensus process, the Expert Panel developed a set of OMH Standards. Public comments were solicited and considered in preparation of the final manuscript. RESULTS Three comparative peer-reviewed studies of OMH met the inclusion criteria. In addition, the results from 16 studies of clinical pathways and one systematic review of survivorship care plans informed the evidence review. Limitations of the evidence base included the small number of studies of OMH and lack of longer-term outcomes data. More data were available to inform the specific Standards for pathways and survivorship care; however, outcomes were mixed for the latter intervention. The Expert Panel concluded that in the future, practices should be encouraged to publish the results of OMH interventions in peer-reviewed journals to improve the evidence base. STANDARDS Standards are provided for OMH in the areas of patient engagement, availability and access to care, evidence-based medicine, equitable and comprehensive team-based care, quality improvement, goals of care, palliative and end-of-life care discussions, and chemotherapy safety. Additional information, including a Standards implementation manual, is available at www.asco.org/standards.
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Affiliation(s)
- Kim Woofter
- Advanced Centers for Cancer Care, South Bend, IN
| | | | | | - Ronda Bowman
- American Society of Clinical Oncology, Alexandria, VA
| | - Rachel Brodie
- Purchaser Business Group on Health, San Francisco, CA
| | | | - Rose Gerber
- COA Patient Advocacy Network, Washington, DC
| | | | | | | | | | | | - Dennis Zoet
- Cancer and Hematology Centers of Western Michigan, Grand Rapids, MI
| | - John V Cox
- UT Southwestern Medical Center, Dallas, TX
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Osterman CK, Triglianos T, Winzelberg GS, Nichols AD, Rodriguez-O'Donnell J, Bigelow SM, van Deventer H, Sanoff HK, Ray EM. Risk stratification and outreach to hematology/oncology patients during the COVID-19 pandemic. Support Care Cancer 2020; 29:1161-1164. [PMID: 33047163 PMCID: PMC7549726 DOI: 10.1007/s00520-020-05744-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Abstract
Purpose Cancer patients have many medical and psychosocial needs, which may increase during the COVID-19 pandemic. We sought to (1) risk-stratify hematology/oncology patients using general medicine and cancer-specific methods to identify those at high risk for acute care utilization, (2) measure the correlation between two risk stratification methods, and (3) perform a telephone-based needs assessment with intervention for high-risk patients. Methods Patients were risk-stratified using a general medical health composite score (HCS) and a cancer-specific risk (CSR) stratification based on disease and treatment characteristics. The correlation between HCS and CSR was measured using Spearman’s correlation. A multi-disciplinary team developed a focused needs assessment script with recommended interventions for patients categorized as high-risk by either method. The number of patient needs identified and referrals for services made in the first month of outreach are reported. Results A total of 1697 patients were risk-stratified, with 17% high-risk using HCS and 22% high-risk using CSR. Correlation between HCS and CSR was modest (ρ = 0.41). During the first month of the pilot, 286 patients were called for outreach with 245 contacted (86%). Commonly identified needs were financial difficulties (17%), uncontrolled symptoms (15%), and interest in advance care planning (13%), resulting in referral for supportive services for 33% of patients. Conclusion There is a high burden of unmet medical and psychosocial needs in hematology/oncology patients during the COVID-19 pandemic. A telephone-based outreach program results in the identification of and intervention for these needs; however, additional cancer-specific risk models are needed to improve targeting to high-risk patients. Electronic supplementary material The online version of this article (10.1007/s00520-020-05744-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chelsea K Osterman
- Division of Oncology, Department of Medicine, University of North Carolina, 170 Manning Drive, CB 7305, Chapel Hill, NC, 27599, USA.
| | - Tammy Triglianos
- Division of Oncology, Department of Medicine, University of North Carolina, 170 Manning Drive, CB 7305, Chapel Hill, NC, 27599, USA
| | - Gary S Winzelberg
- Division of Geriatric Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Angela D Nichols
- Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | - Sharon M Bigelow
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Hendrik van Deventer
- Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Hanna K Sanoff
- Division of Oncology, Department of Medicine, University of North Carolina, 170 Manning Drive, CB 7305, Chapel Hill, NC, 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Emily M Ray
- Division of Oncology, Department of Medicine, University of North Carolina, 170 Manning Drive, CB 7305, Chapel Hill, NC, 27599, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Miller HD. A Better Path to Value in Cancer Care. JCO Oncol Pract 2020; 16:228-230. [DOI: 10.1200/op.20.00206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Harold D. Miller
- Center for Healthcare Quality and Payment Reform, Pittsburgh, PA
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