Patient Care Coordination Research Articles

Clinical laboratory services for primary healthcare centers in urban cities: a pilot ACO model of ten primary healthcare centers

BackgroundPrimary healthcare centers (PHC) ensure that patients receive comprehensive care from promotion and prevention to treatment, rehabilitation, and palliative care in a familiar environment. It is designed to provide first-contact, continuous, comprehensive, and coordinated patient care that will help achieve equity in the specialty healthcare system. The healthcare in Saudi Arabia is undergoing transformation to Accountable Care Organizations (ACO) model. In order for the Kingdom of Saudi Arabia (KSA) to achieve its transformational goals in healthcare, the improvement of PHCs’ quality and utilization is crucial. An integral part of this service is the laboratory services.MethodsThis paper presents a pilot model for the laboratory services of PHC's in urban cities. The method was based on the FOCUS-PDCA quality improvement method focusing on the pre-analytical phase of the laboratory testing as well as the Saudi Central Board for Accreditation of Healthcare Institutes (CBAHI) gap analysis and readiness within the ten piloted primary healthcare centers.ResultsThe Gap analysis, revealed in-consistency in the practice, lead to lower the quality of the service, which was seen in the low performance of the chosen key performance indicators (KPI's) (high rejection rates, lower turn-around times (TAT) for test results) and also in the competency of the staff. Following executing the interventions, and by using some of the ACO Laboratory strategies; the KPI rates were improved, and our results exceeded the targets that we have set to reach during the first year. Also introducing the electronic connectivity improved the TAT KPI and made many of the processes leaner.ConclusionsOur results revealed that the centralization of PHC's laboratory service to an accredited reference laboratory and implementing the national accreditation standards improved the testing process and lowered the cost, for the mass majority of the routine laboratory testing. Moreover, the model shed the light on how crucial the pre-analytical phase for laboratory quality improvement process, its effect on cost reduction, and the importance of staff competency and utilization.

Development and psychometric properties of surveys to assess provider perspectives on the barriers and facilitators of effective care transitions

BackgroundThe quality of the discharge process and effective care transitions between settings of care are critical to minimize gaps in patient care and reduce hospital readmissions. Few studies have explored which care transition components and strategies are most valuable to patients and providers. This study describes the development, pilot testing, and psychometric analysis of surveys designed to gain providers’ perspectives on current practices in delivering transitional care services.MethodsWe underwent a comprehensive process to develop items measuring unique aspects of care transitions from the perspectives of the three types of providers (downstream, ambulatory, and hospital providers). The process involved 1) an environmental scan, 2) provider interviews, 3) survey cognitive testing, 4) pilot testing, 5) a Stakeholder Advisory Group, 6) a Scientific Advisory Council, and 7) a collaborative Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health in Care Transitions by Evaluating the Value of Evidence) research team. Three surveys were developed and fielded to providers affiliated with 43 hospitals participating in Project ACHIEVE. Web-based survey administration resulted in 948 provider respondents. We assessed response variability and response missingness. To evaluate the composites’ psychometric properties, we examined intercorrelations of survey items, item factor loadings, model fit indices, internal consistency reliability, and intercorrelations between the composite measures and overall rating items.ResultsResults from psychometric analyses of the three surveys provided support for five composite measures: 1) Effort in Coordinating Patient Care, 2) Quality of Patient Information Received, 3) Organizational Support for Transitional Care, 4) Access to Community Resources, and 5) Strength of Relationships Among Community Providers. All factor loadings and reliability estimates were acceptable (loadings ≥ 0.40, α ≥ 0.70), and the fit indices showed a good model fit. All composite measures positively and significantly correlated with the overall ratings (0.13 ≤ r ≤ 0.71).ConclusionsWe determined that the items and composite measures assessing the barriers and facilitators to care transitions within this survey are reliable and demonstrate satisfactory psychometric properties. The instruments may be useful to healthcare organizations and researchers to assess the quality of care transitions and target areas of improvement across different provider settings.

The impact of clinical decision making in a molecular tumor board at a tertiary care center.

3128 Background: Multidisciplinary molecular tumor boards were first established with the onset of precision oncology (PO), as many clinicians were unfamiliar with the interpretation and incorporation of the information into clinical practice. PO has since rapidly evolved and integrated itself into standard of care practices for most cancer patients, yet molecular tumor boards have not grown accordingly and in fact some have been discontinued. There remains a paucity of data in regards to the value and impact of molecular tumor board discussions themselves. We previously reported on our longitudinal experiences in PO ( Sadaps et al, 2018), focusing on the therapeutic impact of matched therapy. Here, we report on the utility of our molecular tumor board in clinical decision making. Methods: We conducted a retrospective review of patients seen at Cleveland Clinic with a solid tumor malignancy who had large panel, next-generation-sequencing (NGS) performed via any commercial platform from November 2019-January 2021. Cases were filtered through a local therapeutic algorithm and then reviewed individually. Initial review was performed by a core genomics committee comprised of 2 oncologists and 2 genetic counselors. Interesting and/or complex cases were flagged for discussion at our bimonthly molecular tumor board, which is regularly attended by medical oncologists, pathologists, genetic counselors, bioinformaticians, and patient care coordinators. Data analyzed included categorization of treatment recommendations and the percentage of cases for which initial recommendations were changed based on tumor board discussion. Results: Of 782 total cases, 575 (73.5%) had a clinically relevant genomics tumor board (GTB) recommendation as compared to 51.7% from our previously reported study. 16.7% of patients had on label recommendation(s) and 86.4% had off label/ clinical trial recommendation(s). 179 (22.9%) patients were recommended for genetic counseling (GC). During our bimonthly GTB, we discussed 173 (22.1%) of these cases. Of the discussed cases, the most common tumor types were hepatobiliary (18.5%), lower gastrointestinal (17.3%), and breast (16.2%). Topics of discussion at GTB included such things as pathologic/histologic/molecular testing, prioritization of available trials, appropriateness of an off label therapy, and need for a genetics consult. Discussion at GTB resulted in a change in treatment recommendation in 63 (36.4%) cases. Conclusions: Discussions from multidisciplinary molecular tumor board impacted treatment decisions for our patients. Referral to GC was also common and should be considered an integral part of somatic sequencing review. Molecular tumor boards remain a crucial platform for treatment guidance and clinical management, especially given the increase in “actionability” over the years due to newly discovered targets and targeted therapies in this rapidly evolving field.

Clinicians’ perspectives on strategies to improve cross-institutional collaboration and coordination of pancreatic cancer care for rural patients.

e13532 Background: Rural pancreatic cancer patients often lack access to high-volume pancreatic cancer specialists. This lack of access can result in fragmented cancer care—when patients receive care at multiple institutions—and necessitates that specialists engage in cross-institutional collaboration. In the context of fragmented pancreatic cancer care, the strategies specialists use to facilitate collaboration across institutions are poorly understood. Methods: We conducted semi-structured interviews with cancer specialists (medical, surgical, and radiation oncologists) from a high-volume pancreas cancer center (n = 9) and rural community cancer centers (n = 11) to examine specialists’ coordination practices related to treating and co-managing pancreatic cancer patients across their respective institutions. Using qualitative methods, two of the co-authors independently coded the interview transcripts to identify themes related to cross-institutional coordination practices, noting improvement opportunities and facilitative strategies. Results: Cancer specialists described multiple practices to coordinate cross-institutional care including one-on-one phone calls and using a shared electronic medical record or secure email to exchange clinical notes. In recognizing the limitations of these practices, specialists acknowledged the need to develop and implement communication systems that could facilitate real-time discussions and information sharing between high-volume and rural specialists to coordinate diagnostic and treatment plans. Cross-institutional virtual tumor boards were viewed as a potentially useful approach to foster shared clinical decision-making and treatment plan development across institutions, but specialists perceived that logistical, institutional, and technological challenges could limit the use of this approach. Regardless, specialists indicated that cross-institutional virtual tumor boards could help disseminate treatment recommendations as well as identify barriers to care for mutually-shared rural cancer patients. Specialists also indicated that a dedicated patient navigator could help facilitate cross-institutional coordination by bridging communication between specialists while also assisting cancer patients with issues related to housing, transportation, scheduling, and treatment finances. Conclusions: It is important for cancer specialists treating rural cancer patients to have strategies that support efficient communication and decision-making. Cross-institutional virtual tumor boards and dedicated patient navigators are two such strategies that may help facilitate collaboration between high-volume and rural cancer specialists. Future research should examine the impact of these strategies on patients receiving cancer care at multiple institutions.

Systemic contradictions as causes to challenges in nurses' transitional care: A change laboratory intervention

BackgroundTransitional care involves coordination of care for patients transitioning between primary care and hospital care. This necessitates collaboration with patients, health professionals and organizations with different goals for patient care. This can result in fragmented patient care pathways. Education of health professionals is a means to improve transitional care. We therefore developed a learning intervention in order to enable nurses to develop transitional care. ObjectiveThe objective was to understand how participants identified needs for development can improve transitional care. DesignThe design was that of a formative intervention design based on Cultural Historical Activity Theory. SettingA regional hospital and a primary care department in a municipality in Denmark. ParticipantsNine health professionals from primary care services and seven health professionals from hospital services. MethodThe change laboratory method and the principle of double stimulation guided the facilitation of the learning intervention, which consisted of nine learning sessions (from May to October 2019). A quantitative and qualitative analytical framework was used for data analysis. ResultsThe participants identified needs for development, including a wish to involve patients and their next of kin more and to emphasise relational care. Participants developed an appreciation of challenges concerning collaboration between nurses and the formation of nursing practice. Furthermore, participants began to view challenges as caused by a systemic contradiction between nurses' preoccupation with bureaucratic and managerial demands and patients' expectations of coherent care in transitional care. ConclusionThe process of understanding challenges enabled the participants to change their perception from a need to solve problems as they appear on the surface to a need to address underlying systemic contradictions. This possibly has far-reaching consequences for long-term processes underpinning the development of practice and may serve as an alternative to expedient problem solving.

Registry-Managed Care Coordination and Education for Patients With Co-occurring Diabetes and Serious Mental Illness.

Longitudinal changes in health outcomes of patients with serious mental illness and co-occurring diabetes were examined after introduction of an intervention involving electronic disease management, care coordination, and personalized patient education. This observational cohort study included 179 patients with serious mental illness and diabetes mellitus type 2 at a behavioral health home in Chicago. The intervention employed a care coordinator who used a diabetes registry to integrate services; patients also received personalized diabetes self-management education. Outcomes included glucose, lipid, and blood pressure levels as assessed by glycosylated hemoglobin, low-density lipoprotein, triglycerides, and systolic/diastolic values from electronic medical records and completion of specialty visits confirmed with optometrists and podiatrists. Interrupted time-series segmented random-effects regression models tested for level changes in the eight study quarters following intervention implementation compared with eight preimplementation study quarters, controlling for clinic site and preimplementation secular trends. Significant declines were found in levels of glucose, lipids, and blood pressure postimplementation. In addition, completed optometry referrals increased by 44% and completed podiatry referrals increased by 60%. Significant improvement in medical outcomes was found among patients of a behavioral health home who had comorbid diabetes and mental illness after introduction of a multicomponent care coordination intervention, regardless of which clinic they attended.

Assessment of Learning, for Learning: Operationalizing Milestones Data for Program-Level Improvement.

Assessment of Learning, for Learning: Operationalizing Milestones Data for Program-Level Improvement.

Telemental Health and the Management of Psychosis.

Purpose of ReviewThe purpose of this paper is to review the application of telehealth in the assessment and treatment of psychotic illnesses. We present the contextual factors which make this approach to clinical care compelling, and review existing evidence about feasibility, acceptability, and effectiveness.Recent FindingsThe use of telehealth with individuals that suffer from serious mental illness and psychosis has been demonstrated to be feasible and acceptable, with effectiveness that is comparable to in-person clinical care. Telehealth holds the additional promises of expanding access, connecting patients, families, and the general public to behavioral health resources, and reducing overall health care costs.SummaryWe provide two case examples which demonstrate the successful use of technology for the delivery and coordination of effective patient care for individuals with psychotic illnesses.

2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure).

2021 ACC/AHA Key Data Elements and Definitions for Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Heart Failure).

Multi-sided platform and data-driven care research

Multi-sided platforms in healthcare often focus their business model on standardizing care for wide-spread, chronic diseases. However, there is a lack of knowledge surrounding platform business models enabling individualized care coordination for patients with rare diseases. This paper analyses the development of a complex platform business model addressing Amyotrophic Lateral Sclerosis, a severe neurological disease that requires the coordination of a diverse network of medical specialists, care, and equipment providers. A longitudinal case study examines the platform’s development, focusing subsequently on qualitative and efficient care coordination, care research, and active and direct involvement of patients, as well as establishing two business models, namely, care coordination and care research. We reconstruct how these complex platform business models were configured to improve patient care and care research, thereby creating immediate value for patients and insights for long-term care improvements. The ongoing platform development carefully balances value generation for diverse stakeholders and economic sustainability.

Nursing Care Coordination for Patients with Complex Needs in Primary Healthcare: A Scoping Review.

Introduction:Millions of people worldwide have complex health and social care needs. Care coordination for these patients is a core dimension of integrated care and a key responsibility for primary healthcare. Registered nurses play a substantial role in care coordination. This review draws on previous theoretical work and provides a synthesis of care coordination interventions as operationalized by nurses for complex patient populations in primary healthcare.Methodology:We followed Arksey and O’Malley’s methodological framework for scoping reviews. We carried out a systematic search across CINAHL, MEDLINE, Scopus and ProQuest. Only empirical studies were included. We performed a thematic analysis using deductive (the American Nurses Association Framework) and inductive approaches. Findings were discussed with a group of experts.Results:Thirty-four articles were included in the synthesis. Overall, nursing care coordination activities were synthesized into three categories: those targeting the patient, family and caregivers; those targeting health and social care teams; and those bringing together patients and professionals. Interpersonal communication and information transfer emerged as cross-cutting activities that support every other activity. Our results also brought to light the nurses’ contribution to care coordination efforts for patients with complex needs as well as critical components that should be present in every care coordination intervention for this clientele. These include an increased intensity and frequency of activities, relational continuity of care, and home visits.Conclusion:With the growing complexity of patient’s needs, efforts must be directed towards enabling the primary healthcare level to effectively play its substantial role in care coordination. This includes finding primary care employment models that would facilitate multidisciplinary teamwork and the delivery of integrated care, and guarantee the delivery of intensive yet efficient coordinated care.

Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes.

Racial and ethnic disparities exist in diabetes prevalence, health services utilization, and outcomes including disabling and life-threatening complications among patients with diabetes. Home health care may especially benefit older adults with diabetes through individualized education, advocacy, care coordination, and psychosocial support for patients and their caregivers. The purpose of this study was to examine the association between race/ethnicity and hospital discharge to home health care and subsequent utilization of home health care among a cohort of adults (age 50 and older) who experienced a diabetes-related hospitalization. The study was limited to patients who were continuously enrolled in Medicare for at least 12 months and in the United States. The cohort (n = 786,758) was followed for 14 days after their diabetes-related index hospitalization, using linked Medicare administrative, claims, and assessment data (2014–2016). Multivariate logistic regression models included patient demographics, comorbidities, hospital length of stay, geographic region, neighborhood deprivation, and rural/urban setting. In fully adjusted models, hospital discharge to home health care was significantly less likely among Hispanic (OR 0.8, 95% CI 0.8–0.8) and American Indian (OR 0.8, CI 0.8–0.8) patients compared to White patients. Among those discharged to home health care, all non-white racial/ethnic minority patients were less likely to receive services within 14-days. Future efforts to reduce racial/ethnic disparities in post-acute care outcomes among patients with a diabetes-related hospitalization should include policies and practice guidelines that address structural racism and systemic barriers to accessing home health care services.

Family Caregiver Problems in Outpatient Palliative Oncology.

Background: Understanding challenges of family caregivers within specific palliative care contexts is needed. Objective: To describe the challenges of family caregivers of patients with cancer who receive outpatient palliative care. Methods: We summarized the most common and most challenging problems for 80 family caregivers of cancer patients receiving outpatient palliative care in the midwestern United States. Results: Caregiver worry and difficulty managing side effects or symptoms other than pain, constipation, and shortness of breath were most common. "Financial concerns" was cited most as a "top 3" problem. Almost half of caregivers reported "other" problems, including family members, patient physical function, care coordination, and patient emotional state. Conclusions: The most common and most challenging problems of family caregivers of cancer patients receiving outpatient palliative care may differ from those experienced in other serious illness care contexts. Comparative studies on caregiver problems across the cancer care continuum can help develop and refine interventions.

Specific model for the coordination of primary and hospital care for patients with diabetes mellitus. Evaluation of two-year results (2015–2017)

IntroductionDiabetes mellitus (DM) is one of the most prevalent chronicdiseases and has a significant health and social impact. Strict control of blood glucose levels and other risk factors for vascular disease (VD) reduces complications and mortality and is related to the quality of care received. Although care should be interdisciplinary, based on the coordination of primary care (PC) and hospital care (HC), little information is available on the effectiveness of the different existing intervention models. ObjectiveTo assess, in a population with DM from a healthcare area, the impact on health, quality of care, and effectiveness in the use of resources of a specific model of shared management of patients with DM (Instrument for Evaluation of Models of Chronic Care in Diabetes Mellitus; IEMAC-DM). Patients and methodsA quasi-experimental before-after intervention study in patients with DM in the Cádiz-San Fernando Healthcare Area (Andalusia, Spain) that allows for identifying the capacity of the program to improve the quality indicators both in the whole population with DM and in that referred to HC. For this, a working group consisting of healthcare professionals of different profiles and care levels was set up. An initial self-assessment was done using the IEMAC-DM tool and, after analysis of the preliminary results, improvement strategies were established and implemented. Finally, the clinical and resource management results were assessed before and two years after the implementation of the model. ResultsDuring the study period, no significant changes were seen in process indicators related to laboratory practices or examinations in the health area. The proportion of patients with acceptable metabolic control [glycosylated hemoglobin (HbA1c) level < 8%] was 49% in 2015 and 45% in 2017. The number of admissions related to acute myocardial infarction (AMI) and stroke remained constant, but there was an increase in the standardized ratio of major lower limb amputations (1.5 vs. 1.9). Of the 295 patients referred from PC to HC, the proportion of adequate referrals increased from 40% in 2015 to 76% in 2017 (P = .001). In the referred patients, a significant improvement was seen in the mean difference in glycosylated hemoglobin levels (HbA1c; 1.14 ± 1.73%; 95% CI: 0.73–1.55; P = .0001) and cholesterol (11.28 ± 40 mg/dL; 95% CI: 2.07–20.48; P = .012). ConclusionsThis study shows that an intervention based on a chronicity care model adapted to patients with DM improves certain aspects related to the quality of care and the degree of metabolic control. Improving health outcomes will require long-term evaluation and, probably, other additional interventions.

Utilizing a Behavioral Health Bundle to Improve Patient and Clinician Safety for Hospitalized Children

A multidisciplinary team developed and implemented a BH intervention bundle that included a BH equipment cart, an electronic medical record tool for BH patient identification/stratification, a de-escalation team, daily operational BH phone call, and staff training with a safety checklist. The primary outcome measure was the number of reported safety events in BH patients. Process measure was "medically avoidable days", wherein a medically cleared patient remained hospitalized awaiting transfer to inpatient psychiatric units; balance measure was staff perception of the workflow. Although not statistically significant, we noted a downward trend in safety events per 1,000 patient days from 0.47 preintervention to 0.34 postintervention (28% decrease). Special cause variation was not achieved for BH safety events or medically avoidable days. Although one-third of staff members felt the BH bundle was helpful, many reported it as impeding workflow and expressed ongoing discomfort caring for BH patients. The implementation of a BH intervention bundle requires significant institutional support and interdisciplinary coordination. Despite additional training, equipment, and staff support, we did not achieve measurable improvements in patient safety and care coordination. Additional studies to measure impact and improve care for this population are needed.

Insights from the Pandemic: Patient Testimonials and Care Coordinator Experiences

Abstract My workflow as a Care Coordinator for Evergreen Health (Buffalo, NY) was drastically impacted by the COVID-19 pandemic. As an essential worker, my colleagues and I are on the frontlines of medical and social service delivery to at-risk populations in Western New York (WNY). Having experience in ethnographic and qualitative research, The Center for Care Coordination requested that I develop a report to capture insights from our patients and my co-workers on the best practices for working remotely. My applied research transcribed, coded, and analyzed the data for themes and is presented in Section 1: Patient Success Stories and Section 2: Care Coordinator Interviews. The patient success stories identified: barriers, accomplishment, support, and impact as themes. From the staff interviews, I determined: pandemic challenges, adapting, patient encounters, and future recommendations were the points of discussion. My associates and I are the direct lines of communication between patients and medical providers. Our insights are invaluable in navigating this public health crisis and improving health outcomes.

Improving care coordination for patients 65 and older

Improving care coordination for patients 65 and older

A model of care coordination for patients with complex health and social care needs - what is best?

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.

Abstract PS7-22: Multidisciplinary Tumor Board in Breast Cancer: Results from a large international survey involving 71 countries

Abstract Introduction: Multidisciplinary tumor boards (MTB) offer patients (pts) access to multidisciplinary care and may lead to more efficient, cost-effective and evidence-based treatments and better outcomes. Data regarding the implementation and functioning of breast cancer (BC) MTB worldwide and according to countries’ income are lacking. Methods: We developed a survey, which was disseminated to healthcare professionals working in BC through the use of social networks and emails (accessible from 15 May to 3 July 2020). Countries’ income classification was defined according to the World Bank Atlas method. Results: We obtained 675 responses from 71 countries (40% Western Europe, 14% Eastern Europe, 13% Latin America, 13% Asia, 11% Oceania, 5% North America, 3% Africa; 71% high income, 28% middle income, 1% low income countries). More than half of the respondents were medical oncologists (55%), followed by surgical oncologists (12%), clinical oncologists (11%) and radiation oncologists (7%). Over 60% were between 30-49 years of age and 55% had &amp;gt;10 years of medical practice. MTBs from academic institutions (43%), dedicated cancer centers (30%), public (19%) and private (18%) institutions were reported. Overall, 11% of respondents do not have regular MTBs in their institution, with discrepancies among regions: 34% of respondents from Asia, 18% from Africa, 17% from Eastern Europe, 14% from Latin America, 3% from Western Europe, 2.6% from Oceania and none from North America. This corresponds to 43% of respondents from low income, 22% from middle income and 5.6% from high income countries. Among these, 42% have their patients informally discussed between departments, 23% within a single department and the decision is taken only by the attending physician in 31% of the cases. Eighty-nine percent of respondents (N=602) have regular MTBs, of which 69% are dedicated to BC; 71% discuss all stage I-IV BC cases before any treatment decision, whereas 18% only present new BC cases, before starting any form of treatment and 11% discuss only early BC cases. Above 80% have &amp;gt;4 disciplines represented (18% have 1-3, 44% 4-6, 37% 7-9 and 13% &amp;gt;10). The most represented discipline is medical oncology (98%), followed by surgical oncology (94%), radiation oncology (90%), pathology (87%) and radiology (80%), among others. A nurse is present in 49% of MTB, a psychologist/psychiatrist in 19%, a social worker in 11% and the doctor in charge of the patient in 25%. Pts are not present in 80% of MTB in high income countries, in 44% in middle income and in 29% in low income. Half of respondents reported that it is not mandatory for the treating doctor to implement the decision of the MTB. For 72%, the decision of the MTB is implemented in &amp;gt;75% of the cases, but only 24% have a quality control to check this. When asked about the results of an effective BC MTB, respondents agreed that it resulted in improved clinical decision making (95%), more coordinated patient care (86%), evidence-based treatment decisions (89%), shorter time to tests/treatments (60%) and improved survival (50%). During the COVID19 pandemic, 5% of all MTB were cancelled, 50% switched to virtual meetings, 16% maintained physical MTB with adjustments (social distance/personal protective equipment). Only 7% believe that all MTB will remain virtual, 40% think that MTB will return to their original physical version and 53% that there will be an alternating scheme. Conclusions: The vast majority of participants reported having regular MTBs in their institution, with a high rate of uptake of MTB recommendations. Differences in the implementation of MTB according to the countries’ level of income can be observed and highlights the need to scale-up MTB coverage around the world, especially in low/middle income countries. The COVID19 pandemic led to a high adoption of virtual MTB, which may have long-term effects. Citation Format: Rita Saúde-Conde, Sofia Ferreira, Mariana Brandão, Gil Morgan, Evandro de Azambuja. Multidisciplinary Tumor Board in Breast Cancer: Results from a large international survey involving 71 countries [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-22.

Abstract PS9-17: Nurse navigation in the ambulatory oncology clinic: Patient-centered findings from a survey of 50 breast cancer patients

Abstract Introduction A nurse navigator is a registered nurse who serves as a patient advocate, educator, and coordinator for newly referred cancer patients. Nurse navigators assist with the coordination of care before a patient’s first appointment with their provider. In some healthcare centers, they are also the point-person throughout a patient’s entire treatment process. The nurse navigator role is designed to promote cancer patient empowerment through advocacy, educational support, resource navigation, and psychosocial care. Our study attempted to assess the impact of a newly implemented nurse navigator program, in an academic setting, and measure the effect on patient knowledge, care coordination, and emotional well-being before their breast oncology appointment. Methods A mixed-methods approach was implemented. We provided an Institutional Review Board-approved 9-question survey created from items adapted from Patient Satisfaction with Interpersonal Relationship with Navigators (PSN-I) to UCSF Breast Care Center patients before their first appointments with a breast oncology provider. After survey completion, patients were asked to participate in an open-ended interview about their patient experience with a member of the study team. Results 50 patients were surveyed. 22 (44%) patients surveyed had nurse contact and 28 (56%) did not have prior nurse contact before their appointment. With regards to patient knowledge prior to the oncology appointment, 16 out of 22 (73%) of patients with nurse contact felt informed compared to 16 out of 28 (57%) of patients without nurse contact. With regards to having initial questions answered before their visit, 11 out of 22 (50%) of patients with nurse contact strongly agreed compared to 4 out of 28 (14.3%) of patients without nurse contact. In response to the statement, “my care is coordinated effectively in the Breast Care Center,” 15 out of 22 (68%) of patients with nurse contact strongly agreed compared to 12 out of 28 (43%) of patients without nurse contact. Patients with nurse contact were asked whether speaking with a nurse did 1) improve their patient experience and 2) better deal with stressful emotions. Among 22 patients with nurse contact, 16 (73%) of patients with nurse contact strongly agreed to statement 1, and 20 (91%) agreed with statement 2. Patients without nurse contact were asked to predict whether nurse contact would 1) improve their patient experience and 2) better deal with stressful emotions. Out of 28 patients, 14 (50%) strongly agreed to both statements. From our open-ended interviews, we found the following themes: appreciation for preliminary knowledge, identification of knowledge gaps, appointment scheduling, and insurance coverage barriers, and humanistic care from nurse navigators. Patients reported that they appreciate not only a nurse navigator’s facilitation in coordination and education but also their companionship during their cancer journey. Conclusions Nurse navigators can play a vital role in improving patient knowledge, workflow/care coordination, and emotional well-being at cancer centers. A greater proportion of patients with initial nurse contact felt informed before their appointment and believed their care was effectively coordinated than those without nurse contact. The majority of patients with nurse contact believed their nurses improved their patient experience and relieved anxiety and stress. Based on this study, we will fully implement initial contact with patients to provide information and coordinate services for in-person visits. Given the changes brought by COVID, that first contact could also be with a nurse or physician via video consult prior to an in-person appointment. Future studies should investigate the impact of a longitudinal nurse navigator in providing continuity of care beyond the first referral. Citation Format: Tianyi Wang, Yash Huilgol, Jennifer James, Jeff Belkora, Janet Black, Carrie D'Andrea, Laura Esserman. Nurse navigation in the ambulatory oncology clinic: Patient-centered findings from a survey of 50 breast cancer patients [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-17.