Two Team-Based Approaches that Improve Cancer Patient Access, Quality

What does team-based cancer care done right look like? Here are two real-word models worth emulating.

Model #1: Coordinating with other specialists

Ann McGreal, RN, oncology nurse clinician at Advocate Lutheran General Hospital in Park Ridge, Illinois, says team-based care for her patients extends far beyond the walls of her practice. She’s created new arrangements with other specialists to ensure patients’ needs are met in a timey manner.

For example, early in her practice’s use of immunotherapy, one of her patients was increasingly tired and complained of pain, but initially just in one joint. After a series of tests, it was determined that this patient had dangerously low adrenal levels-and that meant the patient needed to be put on high-dose steroids and receive an almost immediate appointment with an endocrinologist.

Appointments with endocrinologists typically take about two months from referral to appointment, but an exception was made for this patient due to the urgency.

In response to this experience and others like it, McGreal formalized a process between primary-care nurse navigators at her practice and with endocrinologists at other practices who will squeeze in patients within a few days.

The more formal process removes the need for oncologists to get involved (and ask endocrinologists to take the patients on). Instead, the nurse navigators facilitate these expedited appointments for patients.

Advocate Medical Group was a 2017 Association for Community Cancer Centers Innovator Award recipient for its efforts to improve care for patients on immunotherapy.

Model #2: Coordinating within the practice

At MD Anderson Cancer Center in Houston, Texas, Richard Lindsay, physician assistant and president of the Association of Physician Assistants in Oncology, shares a schedule with one of his practice’s oncologists. The clinical team, which also includes a nurse, cares for between 20 to 25 patients each day; many of the patients receive bone marrow and stem cell transplants.

Unless the patient has complications or asks to see the oncologist, Lindsay will likely see that patient. Alternatively, if he’s busy with another patient, the oncologist will see the patient.

This real-time switching of providers is facilitated by the practice’s EHR, which allows any member of the clinical team to assign a patient to their care.

A more informal work flow is also at play: All three team members share an office, which means Lindsay can ask the nurse on his team to set up labs or consult with a pharmacist about a patient’s medications, and the oncologist can see that Lindsay is busy with another patient and step in to help.

The oncologist on his team will typically see the patient if one of the following occurs: It’s a new patient, the patient has a complication, the patient asks to see the oncologist, or Lindsay is busy with another patient.

For most of the appointments on the shared schedule, Lindsay interviews the patient, does the physical exam, and reconciles their medications. Upon his assessment, Lindsay can end the visit and the patient can go home.

Lindsay also secures patient consent forms, provides education about the risks and benefits of the treatment, and prepares the patient for treatment, while the nurse on the team will work with a pharmacist on medications; for example, chemotherapy treatments are already set up in the EHR as order sets, says Lindsay.

While the oncologist ultimately determines the appropriate treatment for patients, Lindsay shares his recommendations. In addition, the nurse on the team coordinates all diagnostic tests-which Lindsay signs off on-and organizes bone marrow donors.

This work flow allows the oncologist on his team to manage the more challenging patients and to decide on the treatment plans that the care team will follow.