Photo Credit: Boonstudio
Patient-centered care can still be improved, with prioritization of convenience, accessibility and communication from the physician.
Picture a future where patients with cancer who experience complications can bypass hectic emergency rooms to instead receive faster, direct care with cancer center teams they know. Or where location, language, or access limitations are no longer the biggest obstacles to a patient’s care or outcomes. Even for leading quality focused institutions, like our two large, community based cancer care centers in the southeastern United States, this can seem out of reach.
Quality is a priority of cancer care. When we achieve it, we avoid some of the worst aspects of our nation’s fragmented health system: inefficient processes for care teams, bad experiences, poor outcomes for patients, and unnecessary treatments that add significant costs for everyone involved.
But quality is not a fixed entity, and not easily achieved. It requires continuous self-examination and improvement, always from the standpoint of what’s best for patients. Recently, our practices both discovered simple yet powerful processes that could help us now deliver even better care to more of our patients. Our shared experience suggests most practices can find hidden opportunities for improvement if patients are willing to seek them out.
Quality as a Constant Pursuit
Our quality improvement journeys began many years ago. We’ve each invested heavily in quality and safety trainings for our care teams and carefully tracked quality measures at physician and clinic levels. We’ve also embraced patient-centered care models for a long time, recognizing that great care must be convenient, coordinated, and accessible for everyone.
In 2021, we each took our quality care commitments a step further, joining 10 other practice groups and health systems as pilot participants in a new initiative from our professional association, the American Society of Clinical Oncology (ASCO). The program, ASCO Certified, helped us uncover hidden opportunities to elevate our care further.
We were grateful for the certifications we achieved by looking beyond our own institutions. But the greatest pay off was discovering better ways to serve our patients.
“We’re Your Home. Call Us First.”
At Memorial Cancer Institute in South Florida, Dr. Raez’s team discovered they could reduce emergency room visits by 60% by taking full advantage of the “oncology medical home model.” This evidence-based approach puts patients at the center of a coordinated, efficient, and accessible web of services and support.
Among patients in Memorial, data showed that nearly half (48%) of ER visits were for complications that cancer care teams could have addressed, most commonly blood transfusions or hydration. However, patients may have been directed to the ER after seeing their primary care provider, who might not have the oncology-specific knowledge to address the patient’s medical problem.
So, Dr. Raez’s team established a triage system. In effect, patients were told, “We’re your home. Call us first.” The shift required operational changes and additional staffing, but it delivered major payoffs. Beyond obvious cost savings, it has spared patients from potentially serious complications of an unnecessary hospitalization.
Breaking Down Barriers to Patient Care
Tennessee Oncology serves a diverse array of urban and rural communities, Dr. Dickson’s team discovered opportunities to improve the equity of care. The practice had long invested in a full suite of patient-centered services, psychology, palliative care, financial counseling, and more. But close examination revealed the barriers many patients faced to access these offerings were not addressed.
Equipped with new information and support, the practice strengthened and routinized its assessment of every patient’s social determinant of health such as language, internet, transportation access, and more. The team adopted validated screening for household food insecurity and identified several high need clinicals (more than 10-15% food insecure) and then partnered with a community foodbank to help up to 800 patients in the next 2 years. The clinic also hired its first medical director for health equity, strengthened data collection for racial, sex, gender minorities, and is partnering to enhance rural telehealth services.
Best for Patients, Best for our Profession
In the ASCO pilot, experiences like ours were the norm. Despite being a self-selecting group of practices already focused on quality, 90% of participants reported finding new, more efficient ways to provide high-quality care. We recognize that any meaningful quality effort requires substantial time and expense but believe it’s worth everything you pour into it and will be exceeded by the opportunities.
To patients, we’re able to offer a powerful new assurance: when you come to us, you’ll receive care that meets the highest scientific standards, but also the gold standard for patient service. To payers, we demonstrate our seriousness as partners in the pursuit of high-quality, value-based care and for our care teams, we’re reigniting the passion that originally led us to practice medicine. In our experiences, there’s tremendous reassurance knowing that a coordinated team is taking care of each patient’s needs, delivering care according to the best evidence and making each patient’s experience better.
Physicians can lead the way toward high-quality, patient-centered care. We may need a little help to get there, but we can be even better doctors when we do.
