评估新型 4R 肿瘤护理计划模式在乳腺癌中的应用：对安全网和非安全网中心患者自我管理和护理提供的影响。
Evaluation of the Novel 4R Oncology Care Planning Model in Breast Cancer: Impact on Patient Self-Management and Care Delivery in Safety-Net and Non-Safety-Net Centers.
机构信息
Center for Business Models in Healthcare, Glencoe, IL.
Northwestern University Feinberg School of Medicine, Chicago, IL.
出版信息
JCO Oncol Pract. 2021 Aug;17(8):e1202-e1214. doi: 10.1200/OP.21.00161.
PURPOSE
Optimal cancer care requires patient self-management and coordinated timing and sequence of interdependent care. These are challenging, especially in safety-net settings treating underserved populations. We evaluated the 4R Oncology model (4R) of patient-facing care planning for impact on self-management and delivery of interdependent care at safety-net and non-safety-net institutions.
METHODS
Ten institutions (five safety-net and five non-safety-net) evaluated the 4R intervention from 2017 to 2020 with patients with stage 0-III breast cancer. Data on self-management and care delivery were collected via surveys and compared between the intervention cohort and the historical cohort (diagnosed before 4R launch). 4R usefulness was assessed within the intervention cohort.
RESULTS
Survey response rate was 63% (422/670) in intervention and 47% (466/992) in historical cohort. 4R usefulness was reported by 79.9% of patients receiving 4R and was higher for patients in safety-net than in non-safety-net centers (87.6%, 74.2%, = .001). The intervention cohort measured significantly higher than historical cohort in five of seven self-management metrics, including clarity of care timing and sequence (71.3%, 55%, < .001) and ability to manage care (78.9%, 72.1%, = .02). Referrals to interdependent care were significantly higher in the intervention than in the historical cohort along all six metrics, including primary care consult (33.9%, 27.7%, = .045) and flu vaccination (38.6%, 27.9%, = .001). Referral completions were significantly higher in four of six metrics. For safety-net patients, improvements in most self-management and care delivery metrics were similar or higher than for non-safety-net patients, even after controlling for all other variables.
CONCLUSION
4R Oncology was useful to patients and significantly improved self-management and delivery of interdependent care, but gaps remain. Model enhancements and further evaluations are needed for broad adoption. Patients in safety-net settings benefited from 4R at similar or higher rates than non-safety-net patients, indicating that 4R may reduce care disparities.
目的
优化癌症护理需要患者自我管理和协调相互依存的护理的时间和顺序。这些都是具有挑战性的，尤其是在为服务不足的人群提供服务的安全网环境中。我们评估了面向患者的 4R 肿瘤学护理计划模型（4R）对安全网和非安全网机构的自我管理和相互依存的护理提供的影响。
方法
从 2017 年到 2020 年，10 家机构（5 家安全网和 5 家非安全网）对 4R 干预措施进行了评估，纳入的患者患有 0-III 期乳腺癌。通过调查收集自我管理和护理提供的数据，并在干预队列和历史队列（在 4R 启动前诊断）之间进行比较。在干预队列中评估了 4R 的有用性。
结果
干预组的调查应答率为 63%（422/670），历史队列为 47%（466/992）。接受 4R 的患者中有 79.9%报告了 4R 的有用性，安全网中心的患者比非安全网中心的患者更高（87.6%、74.2%， =.001）。干预组在七个自我管理指标中的五个方面明显高于历史队列，包括护理时间和顺序的清晰度（71.3%、55%， <.001）和管理护理的能力（78.9%、72.1%， =.02）。在所有六个指标中，干预组向相互依存的护理的转介明显高于历史队列，包括初级保健咨询（33.9%、27.7%， =.045）和流感疫苗接种（38.6%、27.9%， =.001）。在六个指标中的四个指标中，转介完成率明显更高。对于安全网患者，大多数自我管理和护理提供指标的改善与非安全网患者相似或更高，即使在控制了所有其他变量后也是如此。
结论
4R 肿瘤学对患者有用，并显著改善了自我管理和相互依存的护理提供，但差距仍然存在。需要对该模型进行改进和进一步评估，以实现广泛采用。安全网环境中的患者以与非安全网患者相似或更高的比率从 4R 中受益，表明 4R 可能会减少护理差异。
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