Coordinating Care Across the Cancer Continuum the interface

Care across the continuum of cancer One of the major challenges in cancer care

Patient Centered Care by default The most stressed and least medically informed person in

Patient Centered Care by default To add to the potential confusion there are potentially

The recipe for confusion § An emotionally packed diagnosis § A complicated trajectory of

Our task today § Specifically focus on the transition between primary and specialty care

Care across the continuum of cancer The interface is most obvious at the beginning

So let’s begin… § Nicole Vennell-Roberts, MSW § Nicole demonstrates the complexity of the

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Coordinating Care Across the Cancer Continuum: the interface of primary and oncology care. Putting the issue in perspective

Care across the continuum of cancer One of the major challenges in cancer care is coordination among the many providers across the continuum of care. Patien t LONG-TERM OUTCOMES TYPES OF CARE: POPULATION AT RISK SCREEN &/or Symptomatic • MORTALITY • QUALITY OF CARE DX RX MONITOR INTERMEDIATE OUTCOMES Provider 1 Provider 2 Provider 3 Provider 4 • STAGE AT DX • MORBIDITY Cancer Care Continuum Rev. 1. 26. 06

Patient Centered Care by default The most stressed and least medically informed person in the process becomes the unifying force…. . or not Patien t LONG-TERM OUTCOMES TYPES OF CARE: POPULATION AT RISK SCREEN + or Symptomatic • MORTALITY • QUALITY OF CARE DX RX MONITOR INTERMEDIATE OUTCOMES Provider 1 Provider 2 Provider 3 Provider 4 • STAGE AT DX • MORBIDITY Rev. 1. 26. 06

Patient Centered Care by default To add to the potential confusion there are potentially multiple points of communication when family, nurses and other staff become involved Family Patien t TYPES OF CARE: POPULATION AT RISK SCREEN + or Symptomatic LONG-TERM OUTCOMES • MORTALITY • QUALITY OF CARE DX RX MONITOR INTERMEDIATE OUTCOMES Provider 1 Nurses and Staff Provider 2 Nurses and Staff Provider 3 Nurses and Staff Provider 4 • STAGE AT DX • MORBIDITY Nurses and Staff Rev. 1. 26. 06

The recipe for confusion § An emotionally packed diagnosis § A complicated trajectory of care § A one to many relationship for the patient and his/her provider

Our task today § Specifically focus on the transition between primary and specialty care § Identify issues at the interface that merit further research § 1) Is there evidence that the interface between primary and subspecialty care affects the quality of cancer care or health outcomes? § 2) Are there any tested, systematic solutions to problems at the primary care/sub-specialty care interface? § 3) What, if any potential systematic solutions does information technology offer? § 4) What research is needed regarding the interface? § 5) Are the challenges and research regarding cancer care interfaces germane to other health conditions?

Care across the continuum of cancer The interface is most obvious at the beginning and end of the trajectory Patien t LONG-TERM OUTCOMES TYPES OF CARE: POPULATION AT RISK SCREEN + or Symptomatic • MORTALITY • QUALITY OF CARE DX RX MONITOR INTERMEDIATE OUTCOMES Provider 1 Provider 2 Provider 3 Provider ? • STAGE AT DX • MORBIDITY Rev. 1. 26. 06

So let’s begin… § Nicole Vennell-Roberts, MSW § Nicole demonstrates the complexity of the issue. She did not follow the classic trajectory. § Sign or symptom to diagnosis § Confirmed diagnosis to treatment § Treatment to follow-up monitoring