Care Coordination Research Articles

The role of primary care practitioners in cancer control in South Africa: a systems-based case study

Aim Cancer care has largely been the domain of oncology specialists. With increased awareness of the importance of primary care in the context of universal health coverage, there has been a shift to explore the role of primary care in comprehensive cancer management. This includes health promotion, screening, diagnosing, referral to oncology services, and longitudinal care that includes co-ordination of care, survivorship, and palliative care. This paper focuses on the role of primary care practitioners in health promotion, early detection and care co-ordination. Nurses and doctors who work in primary care are included as primary care practitioners. Methods Using a patient vignette narrative tool, the triad of patient empowerment in the form of enhanced health literacy, clinical competence, and system effectiveness, are discussed as the basis for early cancer detection. A complex intervention to improve primary-level cancer care and the implications thereof for the important role of care co-ordination undertaken by primary care practitioners, is also presented. Findings For effective patient assessment, primary care practitioners must be trained in screening and diagnostic techniques as part of their clinical competencies as generalists. These competencies include risk identification, counselling skills, expert clinical examination, interpretation of basic x-rays, minor surgical skills, interpreting blood tests, and point-of-care ultrasound. Against a backdrop of ongoing budget constraints, consumables and equipment needed for diagnosis should be readily available and referral pathways for patients and specimens should be clearly defined and resourced. Conclusions Primary care practitioners in community-based facilities are well-placed to engage with the psychosociocultural dimensions of care. The SA health system places primary care at the point of closest contact with communities. Efficient care pathways are needed by primary care practitioners to adopt the role of care co-ordinator when patients with suspected or confirmed cancer enter these pathways. When considered alongside the overburdened primary care patient-load and the ever-increasing mix of co-morbidities, the complexity of primary care is appreciated. Understanding the complexities of primary care in the context of cancer control is an important component of a holistic cancer control programme.

Institutional Special Needs Plans In Nursing Homes: Substantial Enrollment Growth But Low Availability, 2006-21.

Institutional Special Needs Plans (I-SNPs) are a type of Medicare Advantage (MA) plan designed for long-term residents of nursing homes or those who live in the community but need a nursing home level of care. I-SNPs provide for on-site nurse practitioners in nursing homes to help improve primary care, care planning, and care coordination. Our study was the first to undertake a nationwide descriptive analysis of the I-SNP market. The share of long-stay nursing home residents enrolled in I-SNPs quadrupled from 2006 to 2021, from 2.2percent to 8.8percent. Despite this growth, nearly 70percent of nursing homes did not have any residents enrolled in I-SNPs in 2021, and in more than 60percent of US counties, there were no I-SNPs available. Nearly 94percent of long-stay nursing home residents who were enrolled in I-SNPs in 2021 were eligible for both Medicare and Medicaid. More research is needed to understand why I-SNPs enter certain markets and why long-stay nursing home residents choose to enroll in them; to assess I-SNP enrollment barriers; and to compare hospital admission rates and quality outcomes among long-stay nursing home residents by I-SNP enrollment status. Increased understanding of I-SNPs could inform policies to address long-standing concerns about the quality of care in nursing homes.

Virtual addressing reality: Development of a virtual social work program to address health-related social needs.

405 Background: Assessment of Health-Related Social Needs (HRSNs) has become an integral part of understanding barriers to care and improving patients’ lives and experiences as they receive cancer care. Increased assessment, however, can result in a raised awareness of unmet needs in oncology patient populations. This tends to highlight gaps in services and necessitate additional staff to attend to these needs. Addressing HRSNs can be facilitated with lay navigators (non-licensed staff), licensed staff, clinical staff, and other members of a multi-disciplinary team. Actions can include, but are not limited to, identification of practical concerns, referrals to community-based organizations (CBOs), referral to the clinical team, or further escalation to a licensed clinical social worker (LCSW). Methods: The National Comprehensive Cancer Network (NCCN) Distress Thermometer screening tool was implemented in July 2023 where patients are screened every 3 months in a community oncology setting. A workflow was established where a clinic staff would administer the screening tool and enter the details of the screening into the EHR system. Based on established criteria, the patient would be referred to the social work team via electronic referral. Due to an increase in screening and subsequent referrals, a virtual team of (5) social workers called Patient Resource Coordinators (PRCs) was established in December 2023 to address the practical concerns and facilitate the coordination of resources based on identified needs. After the team was established, non-urgent referrals were then assigned to a PRC. The PRC could refer to an on-site LMSW/LCSW for higher level of acuity assessment, like crisis support or positive PHQ-9 scores. Results: See Table. Conclusions: The virtual PRC team is able to manage ~55% of referrals made to a social worker based on results from an HRSN screening tool. This has allowed the onsite LMSWs/LCSWs to work at the top of their license and enabled patients to receive support with care coordination and connection to resources. Over time, the referrals managed by the virtual team has increased and their connections to patients have grown. In the future, the PRC team aims to add additional LCSW services to assist patients with higher acuity needs. This will broaden the scope of services available to the patients to address their health-related social needs in a timely manner. PRC Activity Dec ’23 Jan ‘24 Feb ‘24 Mar ’24 Apr ‘24 May ’24 (*May to date at time of submission) # of Referrals Received via EHR 110 542 610 586 1216 570 # of Referrals Assigned to PRC 45 245 299 315 660 312 % of Referrals Assigned to PRC 41% 45% 49% 54% 54% 55% *Secondary Referral to SW 8 9 20 4 # of calls attempted 102 479 536 577 959 448 # of patients reached 38 180 217 270 413 277 % of patients reached 37% 38% 40% 47% 43% 62% # of practical concerns identified 31 131 426 430 742 349 Total Visit Duration (in hrs.) 36hrs 181hrs 348hrs 450hrs 836hrs 485hrs

Development of a novel cancer diagnostic center to facilitate care coordination for patients with new or suspected diagnoses of cancer.

81 Background: Navigating a cancer diagnosis is a multifaceted challenge, characterized by intricate care coordination that creates potential for workup and treatment delays, lapses in care, and potentially negatively affecting clinical outcomes. We have developed a novel physician and advanced practitioner-led cancer diagnostic program (CDP) to help navigate patients with a suspected cancer through the diagnostic and staging workup, discussion of results, and linkage to oncologic care. Patients are referred to the CDP, an administrative intake coordinator creates a medical chart, verifies insurance, gathers records, and schedules appointments. An intake nurse reaches out within 24 hours to obtain clinical information and review of systems. Patients are offered an in-person or video visit with the advanced practitioner for history and physical, labs, and further coordination of testing. Here, we aim to describe the demographic and clinical patterns of referral and clinical outcomes of patients who were referred to a CDP over one calendar year. Methods: We retrospectively analyzed 154 patients with a new cancer diagnosis to have at least 1 encounter at the Johns Hopkins CDP between January 1, 2022, and December 31, 2022. Data were retrospectively collected from medical records and stored within Johns Hopkins REDCap. Descriptive analyses were used to describe the data. Results: Among the 154 total patients included in this analysis, 65.6% were White, 24.7% were Black, 3.2% were Asian, and 1.9% were of Hispanic, Latino, or Spanish origin. Insurance coverage was most frequently (46.8%), Medicare (40.3%), and Medicaid (8.4%). Referral distribution shows 50 inpatient and 104 outpatient referrals. Primary cancer diagnoses were most often gastrointestinal (39.6%), upper airway and lung (26.6%), and genitourinary (9.1%). Conclusions: The Johns Hopkins CDP exemplifies the potential for dedicated diagnostic and treatment initiation programs to improve oncologic care, particularly for vulnerable populations. The center facilitates expedited diagnostic resolution, to increased ease of workup for patients and providers, and potentially improve clinical outcomes such as linkage to care and time to treatment. Accepting referrals from inpatient and outpatient settings captures a broad patient pool, including those who may otherwise experience lapses in care owing to complex care navigation needs. In conclusion, we describe a novel care delivery model to potentially optimize healthcare delivery in oncologic care. Inpatient Referral Outpatient Referral Percent minority populations 34% 23.1% Stage 4 at diagnosis 74% 52.9% Patients initiating treatment with curative intent 42.3% 30% Median length of hospitalization 7 days N/A Median time from pathology results to discharge -2.5 days N/A Median time from pathology results to treatment initiation 20 days 16.5 days

Identifying complex emotional and relational needs of service users in Later Life CMHTs within the Greater Manchester Mental Health NHS Foundation Trust

The Community Mental Health Transformation Agenda places a focus on supporting adults and older adults with severe and enduring mental health difficulties, including care for older adults with complex emotional and relational needs (CERN). Current research has paid little attention to CERN in later life. Studies suggest that older adults with CERN present differently to younger adults. This means services may not be identifying and meeting the needs of these individuals. The aim of this scoping exercise was to understand the prevalence of CERN in older adult community mental health services in Greater Manchester. Data was collected on 347 service users under the Care Programme Approach with later life community mental health teams in Greater Manchester. Data was gathered from the Trust electronic record system and interviews with care co-ordinators. Findings revealed that services users had high levels of complex need, including high levels of service use and high levels of risk, especially for self-neglect. Findings aligned with scoping exercises conducted in other Trusts and provided a better understanding of the needs of this population.

Vertical Integration and Care Experiences Among Medicare Advantage Beneficiaries

Medicare Advantage (MA) beneficiaries are increasingly enrolling in integrated MA plans. Legacy-integrated plans share unique features that may differ from newer integrated MA plans. It is unclear whether integrated and legacy-integrated MA plans are associated with a better beneficiary care experience compared with non-legacy-integrated and nonintegrated MA plans. To assess whether enrollment in integrated, legacy-integrated, non-legacy-integrated, and nonintegrated MA plans is associated with better beneficiary care experiences. This cross-sectional study included MA beneficiaries who responded to Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys conducted annually between 2015 and 2019. Data analysis was performed between October 1, 2023, and July 31, 2024. Medicare Advantage plan integration status, categorized as integrated, legacy-integrated, non-legacy-integrated, and nonintegrated. The CAHPS surveys assessed 9 care experience measures. To assess differences in care experience measures, mixed linear regression analyses were performed, adjusting for demographic characteristics, plan random effects, and state fixed effects. The sample consisted of 857 695 respondents. Their mean (SD) age was 72.6 (10.3) years, and 58.1% were women. A total of 12.7% of respondents were Black, 10.7% were Hispanic, and 71.0% were White. Compared with respondents in nonintegrated MA plans, respondents in integrated MA plans were younger (mean [SD] age, 72.7 [10.3] vs 72.2 [10.3] years, respectively) and were less likely to be Black (13.1% vs 11.2%, respectively), female (58.4% vs 57.2%, respectively), and partially dual eligible (8.7% vs 6.2%, respectively). Integrated MA plans were associated with meaningfully better mean ratings only of customer service (1.6 points [95% CI, 1.1-2.1]) and health plan (1.0 points [95% CI, 0.6-1.5]) compared with nonintegrated MA plans. Legacy-integrated MA plans were associated with meaningfully better mean ratings of drug plan (3.7 points [95% CI, 2.4-5.0]), health plan (3.1 points [95% CI, 1.7-4.5]), customer service (2.8 points [95% CI, 1.3-4.4]), getting appointments and care quickly (2.6 points [95% CI, 1.2-4.0]), health care quality (1.9 points [95% CI, 1.0-2.7]), physicians who communicate well (1.1 points [95% CI, 0.4-1.8]), and care coordination (1.1 points [95% CI, 0.4-1.9]) compared with nonintegrated MA plans. In this study, integrated MA plans were not associated with better beneficiary care experiences compared with nonintegrated MA plans. Legacy-integrated MA plans were associated with higher ratings on all care experience measures compared with both non-legacy-integrated and nonintegrated MA plans. Monitoring of integrated MA plans is needed to assess whether they are adding meaningful value to MA beneficiaries and to determine their effects on the health care system.

Quelles avancées dans la prise en charge du carcinome anaplasique de la thyroïde en 2024 ?

LATEST DEVELOPMENTS IN ANAPLASTIC THYROID CARCINOMA MANAGEMENT IN 2024: Anaplastic thyroid carcinomas (ATCs) represent a rare and undifferentiated form of thyroid cancer with a poor prognosis, typically marked by a median overall survival of four to ten months. However, recent advances have shown improvements due to the more systematic application of molecular testing, targeted therapies, and immunotherapy, alongside the establishment of rapid specialized care protocols in expert centers. Clinically, ATCs often present as a rapidly enlarging cervical mass originating from the thyroid, causing neck, pain and tenderness, dyspnea and dys-phagia, and associated lymphadenopathy, typically in elderly patients. Diagnostic confirmation requires an urgent biopsy, reviewed by a pathologist within the TUTHYREF-path network, with a mandatory search for BRAFV600E molecular alterations. Following diagnosis, care coordination is expedited within an expert center of the ENDOCAN-TUTHYREF network whenever feasible. Initial surgery is rarely an option due to frequent loco-regional cervical invasion. A multimodal treatment approach is essential: BRAF/MEK inhibitors (dabrafenib/trametinib) in cases of BRAFV600E mutation, or chemotherapy in the absence of a molecular target, combined with radiotherapy and, potentially, surgery if the disease becomes resectable following induction therapy. PD-1/PD-L1 targeted immunotherapy, either alone or in combination with targeted therapies, has shown potential to extend survival in some patients; however, predictive biomarkers and the optimal sequencing of immunotherapy (whether as induction and/or maintenance) require further clarification and may vary depending on the clinical context.

Electronic Consultations for Endocrine Conditions: A Scoping Review.

Electronic consultations (e-consults) are a mode of referral increasingly used to provide access to endocrine specialty care without the need for a patient in-person visit. This scoping review aimed to describe the models being used to deliver endocrine care via e-consult, what is known about outcomes of endocrine e-consult, and research gaps. The review was completed using an established methodological framework. PubMed, Embase, CINAHL, and Cochrane were searched for articles published in English between January 1, 2000, and March 21, 2024, that reported on e-consults for endocrine specialty care. The database search yielded 2522 articles, of which 19 underwent data extraction and synthesis. The overall body of endocrine e-consult literature is small and largely observational. Various models for endocrine e-consult programs exist. Findings on feasibility, acceptability, and timeliness are positive and consistent with the larger body of e-consult literature. Data on outcomes are limited but suggest that e-consults are no worse than other referral approaches to lowering A1C. Improvements in outcomes are greater for patients whose primary care providers implement e-consult recommendations. In summary, existing studies support the benefits of e-consults in various aspects of endocrine care quality, but the literature is nascent and there are significant research gaps. Future research should examine how e-consults can best address specific endocrine conditions, with a broad set of outcomes that addresses multiple quality dimensions. Advanced study designs and qualitative methods can help address unresolved questions about e-consults relevant to all specialties, including impact on care coordination and costs and best practices for reimbursement and workflow.

Person-Centered Care Planning for People Living With or at Risk for Multiple Chronic Conditions

The US has a growing population of people living with multiple chronic conditions (MCC), yet the health system is ill designed to meet their needs. Person-centered care planning (PCCP) is an approach to provide comprehensive care that is responsive to the individual to improve health outcomes and increase value. To examine strategies used to provide PCCP for people living with or at risk for MCC, as well as facilitators and barriers to implementation. This qualitative study uses thematic analysis of responses from a Request for Information (RFI) published in the Federal Register soliciting input on PCCP, posted by the Agency for Healthcare Research and Quality (AHRQ) in 2022. The RFI was available for public comment from September 16, 2022, to November 15, 2022. Responses were analyzed between January 2023 and February 2024. Respondents were individuals and organizations who identify as, provide care for, or seek to improve care for individuals living with or at risk for MCC. Some responses represent multiple individuals. Qualitative themes and subthemes of the RFI responses, developed using thematic analysis through inductive and deductive coding of the open-text responses. There were a total of 58 respondents, including clinicians, researchers, patients, caregivers, and representatives from health care payer, practitioner, health system, advocacy, professional, and supporting nonprofit and industry organizations. Researchers identified 9 themes: (1) suboptimal quality of care; (2) person-centered, goal-concordant care; (3) multidisciplinary team-based care and care coordination; (4) prevention across the life course; (5) digital health solutions; (6) workflow; (7) education and self-management support; (8) payment; and (9) achieving community, health system, and payer goals. In this qualitative study of PCCP for people living with or at risk for MCC, challenges to widescale adoption of PCCP were identified along with strategies to address these challenges, including the alignment of payment, policy support, culture change, adoption of meaningful measures, and the need for evidence on strategies to scale and spread PCCP. Insights gained from this analysis can inform research priorities and implementation efforts to advance PCCP as an integral component of routine care.

Enhancing care coordination through transitional care management.

232 Background: West Cancer Center and Research Institute (WCCRI) serves Memphis and the Arkansas, Mississippi, and Tennessee tri-state region as the comprehensive care leader in adult cancer care and research, amounting to over 260,000 visits across 57,000 unique patients in 2023. Cancer patients are predisposed for higher risk of hospital admissions, making uniform care coordination between the discharging hospital and their outpatient oncology care home essential to care continuity. While WCCRI attempted to mitigate readmissions, there was no formalized managed care approach for capturing and responding to unplanned patient hospital visits to prevent readmission. Auditing of claims data suggested nearly 500 patient care opportunities within a four-month period. Methods: To improve continuity of care and decrease preventable readmissions, WCCRI implemented a care transitions process based on the Centers for Medicare and Medicaid's Transitional Care Management (TCM). This required a repeatable approach of proactive outreach to patient upon discharge, a clinical assessment of patient need, and an office visit within fourteen days of discharge. To maximize impact, this project was scoped to patients with unplanned hospital admissions who are at moderate to high risk for readmission. Results: Twelve months after implementation, WCCRI has proactively identified 974 patients qualifying for TCM and successfully scheduled 91.48% for a hospital follow-up appointment with their oncologist. Proactive outreach to patients has led to a 35% increase in office visits within fourteen days of discharge, a key measure of care continuity. Conclusions: Learnings from this implementation project have been spread to formalize hospital follow-up approaches across WCCRI. By aligning policies, engaging stakeholders, and fostering a culture of collaboration and accountability, WCCRI has delivered high-quality, coordinated care, and achieved better patient outcomes.

Dedicated OAM Oncology Navigation program to improve access to medication education, ePRO enrollment, and physician treatment plan completion adherence.

234 Background: Effective coordination of oncology care is essential for optimizing patient outcomes and ensuring adherence to treatment plans. When an Oncology Navigation program is implemented specifically related to patients on Oral Anticancer Medications (OAMs), it directly improves patient access to medication education and treatment adherence through enrollment in ePRO (electronic patient reported outcomes) tracking systems. Currently, there is limited evidence published related to the quantitative impact of dedicated OAM Navigation programs on patient treatment review and coordination visits, and provider completion adherence to treatment plans. Methods: This quality improvement initiative aimed to evaluate the impact of implementing an OAM Navigation program. Data were collected over a 90-day pilot period from a single geographic region within a community oncology practice. The patients’ medical records were reviewed to assess completion of treatment review and coordination visits by an APP or Physician, ePRO enrollment, and provider adherence to completion of treatment plans. Results: Analysis of the data revealed a significant increase in completed treatment review and coordination visits following the implementation of the OAM Navigation program, with a 28% increase observed compared to pre-implementation levels. Enrollment to ePRO system increased from 46 patients’ pre-pilot to 272 patients within the pilot period, a 491% increase in enrollment. Additionally, provider adherence to completion of treatment plans showed a marked improvement, increasing by 50% post-implementation. These findings suggest that the OAM Navigation program effectively facilitated enhanced quality and safety of care provided. Conclusions: Dedicated OAM Navigation programs play a crucial role in improving patient outcomes and optimizing oncology care delivery. Our findings demonstrate the significant positive impact of an OAM Navigation program on increasing patient education, ePRO enrollment, and improving provider adherence to completion of treatment plans. Incorporating OAM Navigation programs into ambulatory oncology practices can lead to more efficient and effective care coordination, ultimately enhancing the quality and safety of care. As we continue to expand and refine this program, we look forward to sharing our research findings and insights with the broader oncology healthcare community.

Challenges in Accessing Community-Based Rehabilitation and Long-Term Care for Older Adult Stroke Survivors and Their Caregivers: A Qualitative Study.

While extensive research has examined the rehabilitation challenges faced by stroke survivors, there is limited literature addressing the difficulties encountered by older adult stroke survivors and their caregivers in accessing rehabilitation and long-term care within the Chinese community. This study aimed to investigate the specific challenges related to access, quality, and coordination of rehabilitation and long-term care experienced by older adult stroke survivors and their caregivers within the Chinese community. A qualitative phenomenological design was employed to explore the lived experiences of stroke survivors and their caregivers within the Chinese community. A purposive sampling method was used to recruit participants from June to August 2023. Participants engaged in face-to-face semi-structured interviews. The data were analyzed using an inductive thematic analysis approach to identify and understand key themes and sub-themes. The study involved 38 participants, consisting of 21 older adult stroke survivors (13 males, 8 females) and 17 family caregivers (7 males, 10 females), recruited from five Chinese community health service stations. The analysis identified four distinct themes and 11 sub-themes that encapsulated the challenges faced by participants. These themes include (1) Difficulties in accessing medical services (insufficient medical resources, lack of rehabilitation resources, and time-consuming processes), (2) Challenges in daily life (inconvenience in daily mobility, inadequate financial support, and difficulties in applying for home care services), (3) Psychosocial stress (loneliness, powerlessness, and worry about burdening others), (4) Insufficient information (lack of awareness of available community services, and limited public health education activities). Older adult stroke survivors and their caregivers in Chinese communities face significant challenges. To improve their well-being and quality of life, it is crucial to address these challenges through enhanced access to healthcare, better support for daily living, and more effective information dissemination. Meeting these needs requires a coordinated effort from healthcare providers, community stakeholders, and policymakers to develop and implement effective, long-term care solutions.

Accessibility of and Barriers to Long-Term Follow-Up Care for Childhood Cancer Survivors

Childhood cancer survivorship programs and long-term follow-up (LTFU) practices are inadequate in most regions of China. To understand the clinician and caregiver perceptions of LTFU care and to identify barriers to adherence to LTFU care in mainland China. This survey study had a 2-phase sequential mixed-methods approach, consisting of a cross-sectional survey followed by semistructured interviews. Participants included oncology clinicians recruited through an educational seminar on LTFU and caregivers recruited through convenience sampling. Data were collected from November 2022 to September 2023. The clinician survey and interview focused on the standards and resources for LTFU care at their practicing institution and barriers to the coordination of LTFU care. For caregivers, the survey and interview focused on their awareness of and participation in LTFU care and their opinions on future LTFU care visits. A total of 101 clinicians (28 [27.7%] male; 73 [72.3%] female; 46 [45.6%] aged >40 to 50 years) completed the survey (response rate: 90.2%) representing 32 institutions from 22 provinces. As for the caregivers' survey, 164 eligible participants (36 [22.0%] male; 128 [78.0%] female) were recruited (response rate: 20.2%). The majority of the caregivers had received a high school or greater education (96 [56.7%]) and were parents of CCSs diagnosed with leukemia (67 [40.9%]), lymphoma or solid tumors (47 [28.7%]), or conditions requiring hematopoietic stem cell transplantation (50 [30.5%]). Most clinicians (74 [73.3%]) reported providing late effects care, yet only 10 (13.5%) had a dedicated follow-up clinic for CCSs. Two-thirds (64 [63.4%]) reported that the LTFU plan for each survivor is solely determined by their clinical judgment. In structured interviews, all doctors admitted to deviating from published guidelines due to challenges in implementing screening recommendations in their settings. Barriers to providing LTFU services included patient-related factors (76 [75.2%]), survivor knowledge deficits (61 [60.4%]), and the absence of dedicated LTFU clinics (61 [60.4%]). Among caregivers responding to the survey, 60 (36.6%) had never heard of late effects. Overall, 22 of 26 caregivers (84.6%) who participated in the interviews were not aware of potential late effects, although 17 (68.0%) could articulate existing conditions and symptoms that their children were experiencing. In this mixed-methods study involving clinicians and caregivers, substantial disparities in the uniformity and accessibility of LTFU in China were observed, suggesting the imperative need for a standardized approach to LTFU care for survivors. This includes advocating for establishment of dedicated clinics, alongside an emphasis on enhanced education and training for both clinicians and caregivers.

Interprofessional Management of (Risk of) Malnutrition and Sarcopenia: A Grounded Theory Study from the Perspective of Professionals.

As our global population ages, malnutrition and sarcopenia are increasingly prevalent. Given the multifactorial nature of these conditions, effective management of (risk of) malnutrition and sarcopenia necessitates interprofessional collaboration (IPC). This study aimed to understand primary and social care professionals' barriers, facilitators, preferences, and needs regarding interprofessional management of (risk of) malnutrition and sarcopenia in community-dwelling older adults. We conducted a qualitative, Straussian, grounded theory study. We collected data using online semi-structured focus group interviews. A grounded theory data analysis was performed using open, axial, and selective coding, followed by developing a conceptual model. We conducted five online focus groups with 28 professionals from the primary and social care setting. We identified five selective codes: 1) Information exchange between professionals must be smooth, 2) Regular consultation on the tasks, responsibilities, and extent of IPC is needed; 3) Thorough involvement of older adults in IPC is preferred; 4) Coordination of interprofessional care around the older adult is needed; and 5) IPC must move beyond healthcare systems. Our conceptual model illustrates three interconnected dimensions in interprofessional collaboration: professionals, infrastructure, and older adults. Based on insights from professionals, interprofessional collaboration requires synergy between professionals, infrastructure, and older adults. Professionals need both infrastructure elements and the engagement of older adults for successful interprofessional collaboration.

Women's Health Care Delivery and Coordination After Transitioning From One Electronic Health Record to Another: Perspectives From Staff in the Veterans Health Administration

ObjectivesThe Veterans Health Administration (VA) is transitioning its 1,300 health care facilities from one electronic health record (EHR) to another. The transition aims to improve care delivery and interoperability; however, specific effects on women veterans, who comprise only 7.5% of the patient population, may be obscured without focused evaluation. We aimed to characterize the perspectives of VA staff regarding the impact of transitioning EHRs on women's health care delivery. MethodsWe conducted semistructured interviews with VA staff members involved in delivering or coordinating care for women at three sites that had transitioned EHRs within the past year. Interviews were audio-recorded and transcribed. We used a rapid, templated qualitative analytic approach to identify salient themes in the data. ResultsWe interviewed 16 staff members across VA departments and roles. Although some participants felt the new EHR held promise, most identified challenges with the EHR rollout and implementation (e.g., insufficient training) and the EHR product (e.g., system inefficiencies and latency). Participants highlighted several ways the EHR transition disproportionately affected care delivery for women veterans, including via backlogs of community care referrals, insufficient opportunities for providers to gain proficiency with sex-specific workflows in the new EHR, and outdated listings for veterans who have changed their names. Participants reported that these issues affected their morale and contributed to decreases in productivity and delayed care. ConclusionsMany of our findings reflect challenges that affect VA staff broadly, whereas others may be compounded among women veterans and the VA staff who serve them. To achieve the goal of delivering timely, equitable, high-quality, comprehensive health care services to women veterans, continued efforts to monitor and address the impacts of the EHR transition on this population are needed.

Telehealth service use and quality of care among US adults with diabetes: A cross-sectional study of the 2022 health information national trends survey.

To characterise telehealth use, reasons for using or not using telehealth and the factors associated with telehealth use among US adults with diabetes. A cross-sectional study. Data were sourced from the 2022 Health Information National Trends Survey. US adults aged 18 years or older with self-reported diagnosis of diabetes (both type 1 and type 2). Past 12-month utilisation of telehealth services, modality (eg, video, voice only), overall perception of quality of care, perceived trust in healthcare system and patient-centred communication score. In an analysis of 1116 US adults with diabetes, representing 33.6 million individuals, 48.1% reported telehealth use in the past year. Telehealth users were likely to be younger, women, with higher income, and urban dwellers. Older adults (≥65 years) were less likely to use telehealth compared with those aged 18-49 years (OR 0.43, 95% CI 0.20 to 0.90). Higher income and more frequent healthcare visits were predictors of telehealth usage, with no significant differences across race, education or location. Across respondents with telehealth usage, 39.3% reported having video-only, 35.0% having phone (voice)-only and 25.7% having both modalities. The main motivations included provider recommendation, convenience, COVID-19 avoidance and guidance on in-person care needs. Non-users cited preferences for in-person visits, privacy concerns and technology challenges. Patient-reported quality-of-care outcomes were comparable between telehealth users and non-users, with no significant differences observed by telehealth modality or area of residence (metro status). Around half of US adults with diabetes used telehealth services in the past year. Patient-reported care quality was similar for telehealth and in-person visits. However, further efforts are needed to address key barriers to telehealth adoption, including privacy concern, technology difficulties, and care coordination issues.

Impact of a Comprehensive Financial Navigation Intervention to Reduce Cancer-Related Financial Toxicity.

Although the need to reduce the impact of financial toxicity among patients with cancer is widely acknowledged, few interventions have been developed to address this issue. We tested a novel, multiphase, patient-centered financial navigation (FN) intervention at a large academic medical center. We developed a financial toxicity screening tool consisting of the Comprehensive Score for Financial Toxicity (COST) measure plus several additional items based on patient feedback. After systematizing the screening process, 50 patients from the North Carolina Basnight Cancer Hospital were enrolled in the FN intervention following a positive screen for financial distress (COST score <23). The FN intervention involved one-on-one consultations with a trained financial navigator and included an initial comprehensive intake appointment to determine patient eligibility for financial assistance and follow-up appointments to discuss paperwork and application(s) status. We assessed preliminary intervention effectiveness (preintervention and postintervention COST scores) and implementation (ie, fidelity, uptake, acceptability). All 50 patients assessed for study eligibility screened positive for financial distress. A total of 46 patients completed both the preintervention and postintervention COST instrument and other measures. Postintervention mean COST scores improved from 6.4 at baseline to 13.3 post-FN (P<.0001), indicating a significant decrease in perceived financial toxicity. Fidelity to the intervention was high and 96% of participants received financial assistance. A patient-centered FN intervention fully integrated into an existing care coordination model can help to decrease the burden of cancer-related financial toxicity among patients with cancer experiencing financial distress. Further studies are needed to test FN interventions in various oncology settings and among targeted populations.

Counting the days: Exploring healthcare contact days during episodes of cancer care.

233 Background: Cancer diagnosis and treatment brings about not only emotional upheavals but also logistical hurdles of navigating a fragmented healthcare system. Little is known about the frequency of healthcare contact for cancer patients and its implications. Healthcare contact days, defined as the number of days a patient spends in direct contact with healthcare professionals outside of home, measures the patient’s interaction with the healthcare system. Methods: Using historical claims data (Part A institutional and Part B ambulatory claims) from the Enhancing Oncology Model (EOM) for 12 practices in The US Oncology Network covering the period between January 2019 to June 2022, we derived healthcare contact days per episode (6-month care periods initiating with the administration of chemotherapy), counting each unique date once. When patients encountered multiple care settings on a single date, the following hierarchy was used: inpatient (IP) &gt; emergency room (ER) &gt; skilled nursing facility (SNF)&gt; hospice &gt; ambulatory care. We further counted contact days for different services conducted during the ambulatory visits. Results: For the 75,246 episodes, an average of 31.9 days per episode (1 in every 6 days) were spent in healthcare contact. Cancer patients’ healthcare contact was predominantly within ambulatory care, and visits with oncology providers exceeded that with all other specialties. ER and IP visits, generally a representation of acute care events, accounted for &lt;10% of the contact days. Conclusions: During cancer treatment, patients spend approximately one-sixth of their time in healthcare contact. The optimal frequency of contact, pattern of primary care support, care of comorbidities, and the interrelationship between acute care and clinician visits are apt for further exploration. Healthcare contact days can reflect different care delivery approaches between providers and may be a metric to assess both healthcare efficiency and accessibility. Understanding caregiver burden and social disparities associated with high contact days offers an opportunity to improve care coordination and streamline healthcare encounters while balancing patients’ care needs. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document. Healthcare contact days. Mean Percentiles 5 th -95 th Per Episode Healthcare Contact Days 31.9 10-65 Ambulatory Visits* 8-55 Chemotherapy 6.6 0-18 Imaging 2.7 0-7 Procedure 1.8 0-7 Radiation 2.4 0-23 Testing 11.8 3-25 Clinician Oncology 6 1-14 Other Specialties 3.4 0-10 Primary Care 2.8 0-8 Facility Visits ER 0.4 0-2 Hospice (Facility) 0.1 0-0 IP 2.7 0-16 SNF 0.8 0-0 *Ambulatory visits days are not mutually exclusive.

Access and adherence to cancer care through the Veteran Affairs Close to Me cancer care service.

111 Background: Diagnosing and treating more than 56,000 Veterans annually, the Veterans Affairs (VA) National Oncology Program (NOP) is one of the nation’s largest integrated providers of oncology services. Within VA, oncology care and parenteral therapies are primarily offered at VA Medical Centers (VAMCs) in urban areas, often inaccessible to rural patients. Issues with travel distance, parking, time, and caregiver support can prevent patients from adhering to treatment appointments as evidenced by historical annual No-Show rates for VAMC infusion clinics that range from 1.1-6.7%. To mitigate potential barriers to access, NOP launched the Close to Me (CTM) cancer care service. The service deploys Registered Nurses (RNs) to local VA Community Based Outpatient Clinics (CBOCs) to administer cancer treatments. VA has opened 23 CTM clinics across 5 geographical regions since October 2021. Methods: The CTM service was implemented at VAMCs with NOP providing direct project management, safety assessment and resources such as a comprehensive implementation toolkit, standard operating procedures, care coordination tools, a tiered risk drug matrix and a standardized Healthcare Failure Mode and Effect Analysis risk evaluation. RNs followed a standardized workflow to assess patient eligibility and verify treatment clearances. Access to care was reported by numbers of unique patients and treatment visits. Patient appointment adherence was monitored by no-show rates documented in the electronic health record. Infusion reactions and medical emergencies were reported by RNs. Travel miles saved was calculated by subtracting the difference in miles round trip from the patient’s home to main VAMC and from home to CBOC, then multiplied by number of treatment visits to CBOC. Results: From October 2021 through April 2024, 23 new CTM clinics opened across 5 regions. 515 unique patients were enrolled for a total of 1,916 patient visits. Treatment appointment no-show rate was 1% across all CTM clinics. The most commonly administered medication classes include gonadotropin-releasing hormone agonist (30%), immune globulin (14.5%), immune checkpoint inhibitors (9.3%) and bisphosphonates (8.3%). Zero infusion reactions or medical emergencies were recorded across 1,430 treatments administered. A total of 204,000 travel miles were saved by patients enrolled in this program. Conclusions: The CTM cancer care service safely optimizes current VA CBOC infrastructure to increase access points to oncology treatment for patients across various geographical regions. CTM reduced travel burden for patients and increased ability to adhere to treatment appointments as evidenced by the service’s low no-show rate. These consistent results across CTM services at VAMCs nationwide have cemented CTM as a safe and effective treatment delivery model to expand access. CTM will be scaled to an additional 30 regions by end of 2025.

P4.15C.01 Improving Care Coordination to Address Healthcare Inequities in Lung Cancer

P4.15C.01 Improving Care Coordination to Address Healthcare Inequities in Lung Cancer