Project 2: Care Integration for Patients with Cancer Treated in Independent Practices

Harvard Medical School, Boston MA

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT: Project 2 - The goal of this Project is to describe care integration for patients with cancer treated in independent oncology practices and to identify forms of care integration associated with better quality and outcomes. Many cancer patients are treated by medical oncologists in independent practices. Their clinicians must deliver high-quality care while also coordinating care across different types of clinicians (e.g., surgeon, radiation oncologist, pharmacists) and multiple settings (e.g., office, pharmacy, hospital, post-acute care and hospice). Medical oncologists have key roles in patients’ initial evaluation, treatment initiation, coordination of multidisciplinary treatment, survivorship care, and palliative and end-of-life care. Project 2 will describe key forms of care integration for medical oncology practices (structural, normative, functional, interpersonal, and process) and assess relationships of different forms of integration with one another (e.g., extent of structural integration with strength of interpersonal integration) and with outcomes demonstrating integrated care for patients. Working with Projects 1, 2, and 4 and the Cores, the team will conduct case studies to learn about mechanisms by which independent oncology practices achieve care integration and to adapt and tailor measures of integration to oncology care. The team will survey practice leaders, managers, clinicians, staff, and patients from a representative sample of independent practices to measure various forms of integration. Using Medicare administrative data, the team will measure key outcomes (including quality of care, utilization, and spending) and examine relationships between these outcomes and various forms of integration. Project 2 aims mirror the overall Project aims: Aim 1: Adapt an existing framework and measurement concepts to describe key forms of integration beyond structural (i.e., functional, normative, interpersonal, process) for oncology care delivered in independent oncology practices using case studies and interviews. Identify mechanisms through which forms of integration may yield improved patient care and better outcomes. Aim 2: Measure care integration in independent practices and assess relationships among different forms of care integration. Determine how and whether these relationships vary by practice and market factors. Aim 3. Assess the association of each form of integration with utilization, spending, and high-quality care delivered in independent oncology practices and assess mechanisms through which integration improves or worsens outcomes and care delivery overall and for patient subgroups such as low-income patients and patients living in rural areas. Defining and assessing how independent practices integrate oncology care and how clinicians and patients experience care integration across the cancer care continuum and understanding how integration is associated with important outcomes will inform policies and practices that improve patient outcomes.