Multidisciplinary care clinics: A model to deliver personalized survivorship care.

Abstract

e19629 Background: Multidisciplinary care models provide a comprehensive approach to improve the care of long-term cancer survivors as recommended by the Institute of Medicine report.. Here we describe a Multidisciplinary Survivorship Care Model and the metrics used to evaluate the delivery of personalized care to long-term survivors. Methods: Critical components used to develop survivorship services included: 1) engaging clinical and administrative leadership; 2) conducting extensive reviews/syntheses of published literature including health promotion, prevention and risk reduction, late treatment effects, and rehabilitative services for each disease-site; 3) determining eligibility criteria to transition patients from active-disease care to survivorship care; 4) developing, implementing, and evaluating algorithms by involving a multidisciplinary team expert-consensus; 5) obtaining approval for integration of algorithms into practice by institutional credentialing and regulatory committees; 6) identifying appropriate survivorship clinics to pilot the feasibility of algorithms in routine clinical operations; 7) performing improvement checks of the clinic operations; and 8) revising operations and scheduling as needed. Metrics used to evaluate the progress of the clinical activity of each multidisciplinary survivorship care clinic (MSCC) included number of unique patients transitioned, number seen, number of arrived appointments, number of summary care plans issued, and survivors’ satisfaction. Results: The MSCCs included gynecology, thyroid, genitourinary, stem cell transplant, breast, head and neck, colorectal, lymphoma, and melanoma, with varied launch dates for each clinic. Between 09/01/2008 and 12/31/2011, there were a total of 7396 unique survivors, 12,741 arrived appointments, and 10,016 summary care plans completed within 30 days from appointment. Conclusions: Dedicated multidisciplinary survivorship care models are a comprehensive approach to deliver long-term survivorship care. Comparative effectiveness and other health outcomes research examining the feasibility, usability, acceptance, and effectiveness of the MSCC by providers and survivors is warranted.