Thematic Analysis of Challenges of Care Coordination for Underinsured and Uninsured Cancer Survivors With Chronic Conditions.
Thematic Analysis of Challenges of Care Coordination for Underinsured and Uninsured Cancer Survivors With Chronic Conditions.
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DOI：
10.1001/jamanetworkopen.2021.19080
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发表时间：
2021-08-02
影响因子：
13.8
通讯作者：
Lee SC
中科院分区：
文献类型：
--
作者：
Balasubramanian BA;Higashi RT;Rodriguez SA;Sadeghi N;Santini NO;Lee SC
在安全网卫生系统的癌症治疗期间和治疗后协调保险不足和未保险的癌症和慢性病患者的护理有哪些障碍？这项对 93 个卫生系统利益相关者进行访谈和观察的定性研究确定了系统层面的挑战（即获得初级保健的挑战、肿瘤学和初级保健临床医生之间缺乏沟通、领导层对护理协调挑战的认识）和临床医生层面的挑战（即角色划分不明确、缺乏临床医生知识和管理癌症和慢性病的准备）。这些发现表明，可能需要将肿瘤学和初级保健联系起来的生存护理提供策略，以满足在分散的美国医疗保健系统中保险不足和未保险的癌症患者的护理协调需求。这项定性研究评估了在癌症治疗期间和治疗后协调癌症和慢性病患者护理的障碍。尽管大多数保险不足和未保险的癌症患者患有多种合并症，但许多人缺乏与初级保健团队的一致联系来管理癌症治疗期间和治疗后的慢性病。这对提供高质量的全面和协调的护理提出了重大挑战。描述在癌症和其他慢性病患者的综合安全网系统中协调护理的挑战和机遇。这项多模式定性研究于 2016 年 5 月至 2019 年 7 月在县资助的垂直一体化安全网卫生系统中进行，包括门诊肿瘤科、紧急护理、初级护理和专科护理。参与者是 93 名卫生系统利益相关者（临床医生、领导者、临床和行政人员），经过战略性和滚雪球式抽样，在会议和日常护理过程中进行半结构化访谈和观察。使用扎根理论方法迭代地进行数据收集和分析，然后进行系统的主题分析来组织数据、审查和解释综合研究结果。对 2019 年 3 月至 2020 年 3 月的数据进行了分析。与肿瘤学和初级保健利益相关者协调癌症和慢性病患者护理经验相关的多层次因素。在对 93 个卫生系统利益相关者的访谈和观察中，确定与护理协调相关的系统层面因素包括获得初级护理的挑战、肿瘤学和初级护理临床医生之间缺乏沟通以及领导层对护理协调挑战的认识。临床医生层面的因素包括角色划分不明确、临床医生缺乏管理癌症和慢性病影响的知识和准备。初级保健可能在为癌症和慢性病患者提供协调护理方面发挥关键作用。这项研究的结果表明，需要制定护理服务策略，通过加强沟通、更好地划分护理团队的角色和职责，以及提高临床医生护理癌症和慢性病患者的知识和准备情况，在肿瘤学和初级护理之间架起桥梁。扩大及时获得初级保健的机会也很关键，尽管在资源有限的安全网环境中具有挑战性。
What are the barriers to coordinating care for underinsured and uninsured patients with cancer and chronic conditions during and after cancer treatment at a safety-net health system? This qualitative study of interviews and observation of 93 health system stakeholders identified system-level challenges (ie, challenges to accessing primary care, lack of communication between oncology and primary care clinicians, leadership awareness of care coordination challenges) and clinician-level challenges (ie, unclear role delineation, lack of clinician knowledge and preparedness to manage cancer and chronic conditions). These findings suggest that survivorship care delivery strategies that bridge oncology and primary care may be required to meet the care coordination needs of underinsured and uninsured patients with cancer amid the fragmented US health care system. This qualitative study assesses barriers to coordinating care for patients with cancer and chronic conditions during and after cancer treatment. Although a majority of underinsured and uninsured patients with cancer have multiple comorbidities, many lack consistent connections with a primary care team to manage chronic conditions during and after cancer treatment. This presents a major challenge to delivering high-quality comprehensive and coordinated care. To describe challenges and opportunities for coordinating care in an integrated safety-net system for patients with both cancer and other chronic conditions. This multimodal qualitative study was conducted from May 2016 to July 2019 at a county-funded, vertically integrated safety-net health system including ambulatory oncology, urgent care, primary care, and specialty care. Participants were 93 health system stakeholders (clinicians, leaders, clinical, and administrative staff) strategically and snowball sampled for semistructured interviews and observation during meetings and daily processes of care. Data collection and analysis were conducted iteratively using a grounded theory approach, followed by systematic thematic analysis to organize data, review, and interpret comprehensive findings. Data were analyzed from March 2019 to March 2020. Multilevel factors associated with experiences of coordinating care for patients with cancer and chronic conditions among oncology and primary care stakeholders. Among interviews and observation of 93 health system stakeholders, system-level factors identified as being associated with care coordination included challenges to accessing primary care, lack of communication between oncology and primary care clinicians, and leadership awareness of care coordination challenges. Clinician-level factors included unclear role delineation and lack of clinician knowledge and preparedness to manage the effects of cancer and chronic conditions. Primary care may play a critical role in delivering coordinated care for patients with cancer and chronic diseases. This study’s findings suggest a need for care delivery strategies that bridge oncology and primary care by enhancing communication, better delineating roles and responsibilities across care teams, and improving clinician knowledge and preparedness to care for patients with cancer and chronic conditions. Expanding timely access to primary care is also key, albeit challenging in resource-limited safety-net settings.
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影响因子：
3
作者：
Graetz I;Reed M;Shortell SM;Rundall TG;Bellows J;Hsu J
通讯作者：
Hsu J
影响因子：
--
作者：
Lee, Simon J. Craddock;Clark, Mark A.;Balasubramanian, Bijal A.
通讯作者：
Balasubramanian, Bijal A.
影响因子：
5.4
作者：
Liberati, Elisa Giulia;Gorli, Mara;Scaratti, Giuseppe
通讯作者：
Scaratti, Giuseppe
影响因子：
39
作者：
Rubinstein, Ellen B.;Miller, William L.;Crabtree, Benjamin F.
通讯作者：
Crabtree, Benjamin F.
DOI：
10.14694/edbook_am.2014.34.205
发表时间：
2014-01-01
期刊：
American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting
影响因子：
--
作者：
Oeffinger, Kevin C;Argenbright, Keith E;Wollins, Dana S
通讯作者：
Wollins, Dana S