Coordination of care for early-stage breast cancer patients

OBJECTIVE: Little is known about how care is coordinated for patients with diseases requiring multidisciplinary treatments. How complex care is coordi nated may affect a patient's chance of receiving the full complement of car e provided by multiple physicians. We sought to describe approaches used to coordinate care for women with early-stage breast cancer, a disease often treated by multiple different disciplines in the outpatient setting. DESIGN: Case studies of 6 hospitals with in-depth semistructured interviews with providers of breast cancer care and their support staff. SETTING: Five hospitals in downstate New York and 1 hospital in upstate New York. PARTICIPANTS: Sixty-seven interviews were conducted including 35 phy sicians, 9 nurses, 4 senior clinical or quality directors, 10 administrativ e assistants, and 9 patient educators and navigators. MEASUREMENTS AND MAIN RESULTS: Content analysis of interviews revealed 7 di fferent coordination mechanisms including tracking of referrals, patient su pport, regularly-scheduled multidisciplinary meetings, feedback of performa nce data, use of protocols, computerized systems, and a single physical loc ation. No site had any systematic mechanism to track results of referrals o r receipt of care provided by other physicians. All physicians used follow- up appointments to check on patients' receipt of care, but only half of the physicians had an approach to follow up missed appointments. Real-time mul tidisciplinary meetings with a patient management focus and systematic use of patient support programs, such as patient educators and navigators, were perceived to be valuable. CONCLUSIONS: Numerous coordination mechanisms exist. No site has the abilit y to systematically track care provided by multiple different specialists. The most valued mechanisms are under the hospital's aegis. Hospitals should consider implementing coordination mechanisms to improve delivery of multi disciplinary care.