A model system. Integration of services for cancer treatment.

The care of pediatric cancer patients continues to grow in complexity. Paradoxically, treatment regimens grow more intensive, while regulatory pressures mandate more outpatient care. The challenge is to integrate services around episodes of illness and encounters over periods of 1-3 years. The approach of the author's clinic has been to create seamless relationships that place the patient at the center of care and address the major boundaries patients face. The inpatient-outpatient boundary has been effectively breached by an inpatient case manager and the simultaneous temporary rotation of an inpatient nurse to the outpatient area for specialty training. Discharge planning has been improved by sharing a nurse with the clinic's major home health care company, providing a direct clinic-home health liaison for patients. Ongoing formal evaluations have documented the effects of the institution of each part of the program. These surveys have indicated that inpatient staff participating in the outpatient rotation are more satisfied with the continuity of care and the availability of divisional resources. Patient satisfaction was extremely high and pediatric oncology discharge planning was rated significantly higher than other pediatric services. Despite rapid growth of the oncology service since 1985 and the personal intensity of care, length of stay has shortened and the number of staff has not required excessive increases to meet the needs of the new model.