A simple and data-driven framework to foster multidisciplinary and timely care in resource-limited settings: A pilot program in Argentina.

Abstract

e13517 Background: While numerous reports discuss various navigation methods and their effectiveness, implementing these programs in low- and middle-income countries (LMICs) is challenging. This study addresses this gap by assessing the feasibility of implementing a simple strategy using a small set of essential data gathered during routine patient care. The aim was to foster multidisciplinary case discussion and monitor key performance indicators (KPIs) to achieve timely access to treatment. Methods: As part of the BOLD initiative (Barriers or Limits Demolished Against Breast Cancer), we started a pilot program with the Breast Unit and the Medical Oncology Consult in the outpatient setting of a public hospital serving a vulnerable population in Buenos Aires City. Using a web-based spreadsheet accessible to both units, a simple framework collecting relevant consultation dates was implemented to assess the timeliness of specialist referrals and treatment initiation. We configured simple time-based alerts to highlight patients who exceeded prespecified timeframes, enabling healthcare providers to promptly reach out to patients, inquire about the reasons for access issues, and provide counseling to address them when possible. Results: The Breast Cancer Unit admitted 38 newly diagnosed patients from Sep/2023 to Nov/2023, of whom 22 (57.9%) had no health insurance. The main program KPIs are described in the Table. Surgery was the most frequent source of treatment delays (58.3%), mainly because of the scarce availability of operating rooms. Alerts from delayed initiation of systemic oncological treatments were present in 11 patients (28.9%). Navigation of those patients attributed the primary source of delays to administrative issues in the prior authorization process (45.5%, n=5), followed by patient-related factors such as social vulnerability and difficulty in coping with required procedures (n=4). Conclusions: A simple framework based on the prospective register of key consultation dates was feasible to implement in the routine care setting of a public hospital serving a vulnerable population. This model promotes quality and equity for breast cancer patients by providing an accessible way for LMICs to ensure a timely referral process, foster multidisciplinary case discussion, and offer patient support to overcome challenges arising primarily from delays within the health system. [Table: see text]