Liu Yan
Cardio-Oncology Service Line, Ascension Texas, Austin, USA.
Cardio-Oncology, Institute for Cardiovascular Health, UT Health Austin/Ascension, Austin, USA.
Cardiooncology. 2023 Mar 27;9(1):16. doi: 10.1186/s40959-023-00167-0.
Despite the rapid growth of cardio-oncology as a subspecialty, cancer patients are still underserved from a cardiovascular perspective. A new care model is needed to integrate comprehensive cardio-oncology care with community-based facilities to improve care access, quality, and equity. Here, we present a cardio-oncology service line model for large, multi-hospital health systems to address this need.
An academic cardio-oncology program was first established using a multidisciplinary approach. Five infrastructure elements for a service line model were created, including strategic accountability, standardized care, dedicated resources, patient experience/education, and branding/identity. We then utilized these elements across our healthcare system to establish a quality-controlled and centrally governed cardio-oncology service line structure. Protocols were created to standardize care and ensure consistency and quality, including referral workflow, imaging, cardiotoxicity surveillance, and clinical management. An IRB-approved cardio-oncology registry was established for outcome tracking.
The standardized cardio-oncology services were expanded to eight hospitals and ten outpatient care centers, including rural outreach offices, resulting in increased patient access and improved clinical quality measures. The service area expanded 17-fold, and an estimated rural population of 204,133 gained access to care. Cardio-oncology office visits increased by approximately 600% three years after implementation of the service line model.
A cardio-oncology service line with standardized care is a feasible and effective care model to improve cardio-oncology care quality, patient access, and health equity in large, multi-hospital health systems. It can be used in conjunction with academic cardio-oncology programs to improve the overall cardio-oncology healthcare efficacy in the US.
尽管心脏肿瘤学作为一个亚专业迅速发展，但从心血管角度来看，癌症患者仍未得到充分的治疗。需要一种新的护理模式，将全面的心脏肿瘤护理与社区设施相结合，以改善护理的可及性、质量和公平性。在此，我们提出一种适用于大型多医院卫生系统的心脏肿瘤服务线模式，以满足这一需求。
首先采用多学科方法建立了一个学术性心脏肿瘤项目。创建了服务线模式的五个基础设施要素，包括战略问责制、标准化护理、专用资源、患者体验/教育以及品牌/标识。然后，我们在整个医疗系统中利用这些要素，建立了一个质量可控且集中管理的心脏肿瘤服务线结构。制定了协议以规范护理并确保一致性和质量，包括转诊流程、影像学检查、心脏毒性监测和临床管理。建立了一个经机构审查委员会批准的心脏肿瘤登记处，用于结果跟踪。
标准化的心脏肿瘤服务扩展到了八家医院和十个门诊护理中心，包括农村外展办公室，从而增加了患者的可及性，并改善了临床质量指标。服务区域扩大了17倍，估计有204,133名农村人口获得了医疗服务。服务线模式实施三年后，心脏肿瘤门诊就诊量增加了约600%。
具有标准化护理的心脏肿瘤服务线是一种可行且有效的护理模式，可提高大型多医院卫生系统中心脏肿瘤护理的质量、患者的可及性和健康公平性。它可与学术性心脏肿瘤项目结合使用，以提高美国整体心脏肿瘤医疗保健的疗效。
