Discern Health, Baltimore, MD.
National Committee for Quality Assurance, Washington, DC.
JCO Oncol Pract. 2020 Dec;16(12):e1441-e1450. doi: 10.1200/OP.20.00231. Epub 2020 Sep 30.
Oncology practices often serve as the "medical home" for patients but may not have systems to support all aspects of patient-centered care. We piloted a new set of oncology medical home standards that call for accessible, continuous, coordinated, and team-based care. We examined how adoption of the standards varies across a variety of practices and compared practice self-report with external evaluation of implementation.
Five medical oncology practices in southeastern Pennsylvania implemented the standards from 2014 into 2016. Implementation support included training webinars and technical assistance. External reviewers evaluated practices' implementation of the standards. We conducted site visits to interview providers and patients.
Between baseline and follow-up, practice self-assessments and independent audits showed practices increased implementation of the patient-centered oncology standards. The largest improvement was seen in continuous quality improvement (QI). Practices were less successful in implementing care coordination: achievement on two standards (access and evidence-based decision support) declined from baseline to follow-up. Qualitative analyses revealed that practices focused QI in five areas: goals of care, engaging patients in QI, financial counseling, symptom management, and care coordination. Interviewees talked about facilitators, such as leadership support and physician buy-in, and barriers to transformation, including inadequate resources and staffing. Health information technology both supported and limited implementation.
Oncology practices showed some progress in their implementation of patient-centered care processes over the course of the pilot program. Systems for tracking and documenting improvement, training for staff and clinicians, leadership support, and alignment of financial incentives are critical to transformation.
肿瘤学实践通常是患者的“医疗之家”，但可能没有系统来支持以患者为中心的护理的各个方面。我们试行一套新的肿瘤学医疗之家标准，要求提供可及、连续、协调和团队式的护理。我们研究了标准在各种实践中的采用情况，并将实践的自我报告与实施的外部评估进行了比较。
宾夕法尼亚州东南部的 5 家肿瘤医学实践在 2014 年至 2016 年期间实施了这些标准。实施支持包括培训网络研讨会和技术援助。外部评审员评估了实践实施标准的情况。我们进行了现场访问，采访了提供者和患者。
在基线和随访之间，实践的自我评估和独立审计显示，实践在实施以患者为中心的肿瘤学标准方面有所增加。最大的改进出现在持续质量改进（QI）方面。实践在协调护理方面的实施效果较差：两项标准（可及性和循证决策支持）的实施情况从基线到随访都有所下降。定性分析显示，实践在五个方面集中进行了 QI：关怀目标、让患者参与 QI、财务咨询、症状管理和护理协调。受访者谈到了一些促进因素，如领导层的支持和医生的认同，以及变革的障碍，包括资源和人员配备不足。医疗信息技术既支持又限制了实施。
在试点项目期间，肿瘤学实践在实施以患者为中心的护理流程方面取得了一些进展。跟踪和记录改进的系统、员工和临床医生的培训、领导层的支持以及财务激励的一致性对于转型至关重要。
