Department of Hematology Oncology, West Virginia University School of Medicine, Morgantown, WV, USA.
Department of Health Policy, Management, and Leadership, West Virginia University School of Public Health, Morgantown, WV, USA.
J Cancer Surviv. 2023 Apr;17(2):509-517. doi: 10.1007/s11764-022-01304-x. Epub 2022 Nov 28.
The prospective surveillance model (PSM) is an evidence-based rehabilitation care delivery model that facilitates functional screening and intervention for individuals undergoing cancer treatment. While PSM is empirically validated and feasible in practice, implementation into cancer care delivery has languished. The purpose of this manuscript is to characterize the barriers and facilitators to implementing PSM in a breast cancer center and to share policy and process outcomes that have sustained the model in practice.
The PSM implementation was undertaken as a quality improvement initiative of our cancer center. We retrospectively assessed barriers to implementation and define those according to the Consolidated Framework for Implementation Research (CFIR). Implementation strategies are defined based on the Expert Recommendations for Implementation Change (ERIC) taxonomy. Breast center policy changes and stakeholder-reported process improvement outcomes at the clinic and system level are described.
PSM implementation facilitation was driven primarily by adapting the model to align with the cancer center workflow, engaging interdisciplinary stakeholders as program champions, enhancing knowledge and awareness among cancer care providers, and changing infrastructure to support the model. System and clinic-level policy and process changes included the development of clinical pathways, EHR order sets and automated referrals, new staffing models, and adapted clinical workflows.
Our report provides insight on implementing the PSM at a single institution in a cancer care delivery setting. Successful implementation strategies addressed individual, clinic, and system-level barriers and facilitated process and policy changes that have enabled PSM sustainment. Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity.
Improving integration of rehabilitation services into oncology care has significant implications for survivorship care by enhancing proactive management of functional morbidity.
前瞻性监测模型（PSM）是一种基于证据的康复护理提供模式，有助于对接受癌症治疗的个体进行功能筛查和干预。虽然 PSM 在实践中经过了实证验证并且切实可行，但在癌症护理提供中的实施却进展缓慢。本文的目的是描述在乳腺癌中心实施 PSM 的障碍和促进因素，并分享维持该模型在实践中运行的政策和流程成果。
PSM 的实施是作为我们癌症中心的一项质量改进计划进行的。我们回顾性评估了实施障碍，并根据综合实施研究框架（CFIR）对其进行了定义。实施策略是根据专家实施变革建议（ERIC）分类法定义的。描述了乳腺中心政策的变化以及利益相关者报告的诊所和系统层面的流程改进结果。
PSM 实施的促进主要是通过调整模型以适应癌症中心的工作流程、让跨学科利益相关者作为项目拥护者、提高癌症护理提供者的知识和意识，以及改变基础设施以支持该模型。系统和诊所层面的政策和流程变化包括制定临床路径、电子病历医嘱集和自动转诊、新的人员配备模式以及调整临床工作流程。
我们的报告提供了在癌症护理提供环境中在单一机构实施 PSM 的见解。成功的实施策略解决了个体、诊所和系统层面的障碍，并促进了流程和政策的改变，使 PSM 得以维持。将康复服务更好地整合到肿瘤学护理中，通过主动管理功能发病率，对生存者护理具有重要意义。
将康复服务更好地整合到肿瘤学护理中，通过主动管理功能发病率，对生存者护理具有重要意义。
