Promoting the Shared-Care Model for Adolescent and Young Adults With Cancer: Optimizing Referrals and Care Coordination With Primary Care Providers

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Background: The “shared-care model” for patients with cancer involves care coordination between primary care providers (PCPs) and oncologists, with the goal of optimizing survivorship care. However, a high proportion of adolescent and young adult (AYA) cancer survivors do not have a PCP. Study objectives were to increase the percentage of AYAs with a PCP documented in the electronic medical record (EMR) via the use of a best practice advisory (BPA) or “stopgap” intervention; to increase communication between providers by the number of routed clinic notes; and to assess oncology providers' attitudes/beliefs about the model and intervention. Methods: Data were collected for the 6 months before implementation of the BPA to determine the percentage of AYAs with a PCP and the number of notes routed to providers (time point 1 [T1]). The same data were collected at time point 2 (T2) after the BPA had been implemented for 6 months. Oncology providers participated in an education video module and an online survey at T1 and a survey at T2. Results: At T1, 47.1% of 756 AYAs had a documented PCP in the EMR. At T2, the percentage increased to 55.1% (P<.002). The number of routed notes did not change significantly from T1 to T2. Providers that completed the intervention survey agreed/strongly agreed that the shared-care model is a desirable model of care (T1 = 86%; T2 = 93%) and that a BPA is useful for facilitating PCP referrals (T1 = 76%; T2 = 39%). Conclusions: This BPA is feasible for increasing the percentage of AYAs with a PCP documented in the EMR and could potentially lead to increased PCP referral and communication among providers for the benefit of long-term survivorship care. Providers generally agree with the shared-care model; however, the BPA implementation requires modification.

Author contributions: Principal investigators: Kinahan (co-PI), Sanford. Advisor: O'Brien. Study design: Kinahan, Kircher, Altman, Rademaker, Didwania, Sanford. Questionnaire development: Kinahan, Salsman. Study implementation, analysis, and manuscript writing: Kinahan, Rademaker, Sanford. Statistician: Rademaker. Video presentation consultation: Kircher. Manuscript review: Rademaker, Salsman, Didwania, O'Brien, Sanford. Correspondence: Karen E. Kinahan, DNP, APN, FNP-BC, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, 675 North St. Clair 21-100, Chicago, IL 60611. E-mail: kkinahan@nm.org

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