BPI20-017: Innovating Patient-Facing Care Pathways in Breast Cancer Using the 4R model, 4R = Right Information / Care / Patient / Time

Authors: Della F. Makower MDa, Christine Brezina Weldon MBAb, Julia R. Trosman PhD, MBAb, Kent Hoskins MD, BAc, Cathleen Schaeffer RN, BSN, OCN, CBCNc, Bruce D. Rapkin PhDa, Melissa A. Simon MD, MPHb, Al B. Benson MD, FACP, FASCOd, and William J. Gradishar MD, FASCO FACPd
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  • a Albert Einstein College of Medicine, Bronx, NY
  • | b Northwestern University, Feinberg School of Medicine, Chicago, IL
  • | c University of Illinois Cancer Center, Chicago, IL
  • | d Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL

Background: ASCO’s “Criteria for High-Quality Clinical Pathways in Oncology” calls for development of multi-modality patient focused pathways. However, clinical pathways are typically created for provider use. The innovative 4R model (right information and right care for the right patient at the right time), developed by the Center for Business Models in Healthcare and Northwestern University, is an approach to pathways which empower patients in conjunction with their care team. The 4R model incorporates recommendations from the Institute of Medicine, Medicare’s OCM, and National Comprehensive Cancer Network’s guidelines: multi-modality planning from diagnosis to survivorship or hospice, specifying clinical team and their responsibilities; and inclusion of definitive and supportive cancer care in the plan. This project was funded by an NCCN/Pfizer grant. Overall Goal: To help breast cancer patients, their families/caregivers, and their care team manage guideline indicated care through use of 4R patient care sequences / pathway plans. Methods: This project implemented the 4R model for a target population of breast cancer patients and care teams at two major institutions serving predominantly minority and underserved patients. Patient self-management metrics were collected via patient survey prior to (historical) and after implementation (4R cohort). Descriptive statistics and Fisher’s exact test were used for analysis Results: Patients who received the care sequence plan reported that their care was explained well/very well 90% (45/50) as compared to 63% (77/123) of patients who did not receive care sequence plans, p=0.0002. There were statistically significant improvements in patients “knowing stage of your cancer”, p=0.0043; and in “never or seldom felt not in control of care”, p=0.0166. Of patients who received care sequence plans, 90% (45/50) found plan very useful or useful. Conclusion: Our project showed that the 4R model is a promising patient self-management method providing early breast cancer patients with their own care pathways. The patient care sequence plans markedly improved several aspects of patient self-management as well as delivery of multi-modality care. An ongoing 4R collaboration continues development of the 4R model to address remaining gaps and improve 4R effectiveness.


Corresponding Author: Christine Brezina Weldon, MBA