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Coordination mechanisms help hospitals improve delivery of multidisciplinary care for early-stage breast cancer patients

Most of the 200,000 women who will be diagnosed with breast cancer in the coming year will have early-stage breast cancer. Coordinating the care of these women is a significant challenge, since different specialists often provide local surgical and radiation treatment, systemic chemotherapy, and hormonal therapies.

Hospitals use a variety of mechanisms to coordinate care for women with early-stage breast cancer, but they lack standardized approaches. Women treated at hospitals with more care coordination mechanisms in place appear more likely to receive effective adjuvant therapies (i.e., followup radiation and chemotherapy), according to a study supported by the Agency for Healthcare Research and Quality (HS09844).

At these high-coordination hospitals, on average, 88 percent of women with breast-conserving surgery received recommended radiotherapy, and 84 percent of those with tumors larger than 1 cm received recommended systemic chemotherapy compared with 76 percent and 73 percent of women, respectively, at lower coordination hospitals. Hospital leadership should consider implementing mechanisms to coordinate care for women with early-stage breast cancer, conclude Nina A. Bickell, M.D., M.P.H., of Mount Sinai Medical Center, and Gary J. Young, J.D., Ph.D., of the Boston University School of Public Health.

They interviewed 67 physicians, nurses, and support staff practicing at 6 hospitals—including those with innovative breast cancer care programs—about hospital- and office-based approaches to coordinating care for their breast cancer patients. These interviews identified seven different coordination mechanisms that ranged from tracking of patient referrals to regularly scheduled multidisciplinary meetings among doctors involved in caring for the same patients. No site had a systematic approach to track receipt of adjuvant care provided by other specialists. Only some physicians' offices had a mechanism to ensure scheduling of followup appointments or recall of patients who missed appointments. Doctors particularly valued the multidisciplinary meetings and patient support programs, such as patient navigators to help patients get to appointments, note the researchers. Although much of the therapy women receive for this condition is delivered in outpatient settings, the researchers conclude that hospitals are in the best position and have the most valued mechanisms for coordination of care provided to women with early-stage breast cancer.

More details are in "Coordination of care for early-stage breast cancer patients," by Drs. Bickell and Young, in the Journal of General Internal Medicine 16, pp. 737-742.

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