Cancer Survivorship Care in Advanced Primary Care Practices A Qualitative Study of Challenges and Opportunities
Cancer Survivorship Care in Advanced Primary Care Practices A Qualitative Study of Challenges and Opportunities
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DOI：
10.1001/jamainternmed.2017.4747
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发表时间：
2017-12-01
影响因子：
39
通讯作者：
Crabtree, Benjamin F.
中科院分区：
文献类型：
--
作者：
Rubinstein, Ellen B.;Miller, William L.;Crabtree, Benjamin F.
重要性尽管国家利益相关者十年的努力，使癌症生存的最前沿的初级保健，有很少的证据表明，初级保健已经开始整合综合服务，以管理长期癌症survivor.Objective护理解释为什么初级保健还没有开始整合全面的癌症生存服务。和参与者对2015年3月至2017年2月在美国招募的12个先进的初级保健实践进行比较案例研究。这些做法是从为罗伯特·伍德约翰逊基金会编制的151名劳动力创新者的国家登记册中选出的。招聘的做法包括政策背景和组织结构的多样性。研究人员在每次实践中进行了10到12天的民族志数据收集，包括与实践人员的访谈和与癌症幸存者的患者路径。现场记录，成绩单，和实践文件进行了分析，并在案件中，以确定突出的themes.Main结果和措施描述癌症生存护理提供先进的以患者为中心的医疗homes.Results相关的障碍和促销因素，包括识别的障碍和促销因素，12个做法来自多个国家和政策背景，并有一个混合的临床医生在家庭或内科培训。除3家外，其他所有医院都被认定为国家质量保证委员会3级以患者为中心的医疗之家。这些做法都没有提供任何类型的全面癌症生存服务。出现了三个相互依赖的解释因素：缺乏一个公认的，独特的临床类别的生存在初级保健;缺乏可操作的信息来治疗这一患者群体;结论和相关性为了增加初级保健转型努力的潜力，将生存服务纳入常规护理，存活率必须成为一个公认的临床类别，并具有由功能性信息系统基础设施支持的可操作护理计划。
IMPORTANCE Despite a decade of effort by national stakeholders to bring cancer survivorship to the forefront of primary care, there is little evidence to suggest that primary care has begun to integrate comprehensive services to manage the care of long-term cancer survivors.OBJECTIVE To explain why primary care has not begun to integrate comprehensive cancer survivorship services.DESIGN, SETTING, AND PARTICIPANTS Comparative case study of 12 advanced primary care practices in the United States recruited from March 2015 to February 2017. Practices were selected from a national registry of 151 workforce innovators compiled for the Robert Wood Johnson Foundation. Practices were recruited to include diversity in policy context and organizational structure. Researchers conducted 10 to 12 days of ethnographic data collection in each practice, including interviews with practice personnel and patient pathways with cancer survivors. Fieldnotes, transcripts, and practice documents were analyzed within and across cases to identify salient themes.MAIN OUTCOMES AND MEASURES Description of cancer survivorship care delivery in advanced patient-centered medical homes, including identification of barriers and promotional factors related to that care.RESULTS The 12 practices came from multiple states and policy contexts and had a mix of clinicians trained in family or internal medicine. All but 3 were recognized as National Committee on Quality Assurance level 3 patient-centered medical homes. None of the practices provided any type of comprehensive cancer survivorship services. Three interdependent explanatory factors emerged: the absence of a recognized, distinct clinical category of survivorship in primary care; a lack of actionable information to treat this patient population; and current information systems unable to support survivorship care.CONCLUSIONS AND RELEVANCE To increase the potential for primary care transformation efforts to integrate survivorship services into routine care, survivorship must become a recognized clinical category with actionable care plans supported by a functional information system infrastructure.