Coordination of Care for Early‐stage Breast Cancer Patients*

Nina A. Bickell, Gary J. Young

Little is known about how care is coordinated for patients with diseases requiring multidisciplinary treatments. How complex care is coordinated may affect a patient's chance of receiving the full complement of care 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. Case studies of 6 hospitals with in-depth semi-structured interviews with providers of breast cancer care and their support staff. Five hospitals in downstate New York and 1 hospital in upstate New York. Sixty-seven interviews were conducted including 35 physicians, 9 nurses, 4 senior clinical or quality directors, 10 administrative assistants, and 9 patient educators and navigators. Content analysis of interviews revealed 7 different coordination mechanisms including tracking of referrals, patient support, regularly-scheduled multidisciplinary meetings, feedback of performance data, use of protocols, computerized systems, and a single physical location. No site had any systematic mechanism to track results of referrals or 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 multidisciplinary meetings with a patient management focus and systematic use of patient support programs, such as patient educators and navigators, were perceived to be valuable. Numerous coordination mechanisms exist. No site has the ability 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 multidisciplinary care.