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Coordinating Cancer Care: Patient and Practice Management Processes Among Surgeons Who Treat Breast Cancer

Katz, Steven J. MD, MPH*; Hawley, Sarah T. PhD†; Morrow, Monica MD‡; Griggs, Jennifer J. MD, MPH§; Jagsi, Reshma MD, PhD¶; Hamilton, Ann S. PhD∥; Graff, John J. MS, PhD**; Friese, Christopher R. RN, PhD, AOCN††; Hofer, Timothy P. MD, MSC‡‡

doi: 10.1097/MLR.0b013e3181bd49ca
Original Article

Objectives: The Institute of Medicine has called for more coordinated cancer care models that correspond to initiatives led by cancer providers and professional organizations. These initiatives parallel those underway to integrate the management of patients with chronic conditions.

Methods: We developed 5 breast cancer patient and practice management process measures based on the Chronic Care Model. We then performed a survey to evaluate patterns and correlates of these measures among attending surgeons of a population-based sample of patients diagnosed with breast cancer between June 2005 and February 2007 in Los Angeles and Detroit (N = 312; response rate, 75.9%).

Results: Surgeon practice specialization varied markedly with about half of the surgeons devoting 15% or less of their total practice to breast cancer, whereas 16.2% of surgeons devoted 50% or more. There was also large variation in the extent of the use of patient and practice management processes with most surgeons reporting low use. Patient and practice management process measures were positively associated with greater levels of surgeon specialization and the presence of a teaching program. Cancer program status was weakly associated with patient and practice management processes.

Conclusion: Low uptake of patient and practice management processes among surgeons who treat breast cancer patients may indicate that surgeons are not convinced that these processes matter, or that there are logistical and cost barriers to implementation. More research is needed to understand how large variations in patient and practice management processes might affect the quality of care for patients with breast cancer.

From the *Department of Internal Medicine and Health Management Policy, University of Michigan Health System, Ann Arbor, MI; †Department of Internal Medicine, University of Michigan Health and HSR&D Center of Excellence, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI; ‡Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; §Departments of Internal Medicine and Health Management and Policy, University of Michigan Health System, Ann Arbor, MI; ¶Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI; ∥Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA; **Department of Preventive Medicine, Wayne State University School of Medicine and Karmanos Cancer Institute, Detroit, MI; ††Division of Nursing Business & Health Systems, School of Nursing, University of Michigan School of Nursing, Ann Arbor, MI; ‡‡Department of Internal Medicine, University of Michigan and HSR&D Center of Excellence, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI.

Supported by the National Cancer Institute (NCI) to the University of Michigan grants R01 CA109696 and R01 CA088370; Established Investigator Award in Cancer Prevention, Control, Behavioral, and Population Sciences Research from the NCI grant K05CA111340 (to S.J.K.); the collection of cancer incidence data used in this study was supported by the California Department of Health Services as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology and End Results Program awarded to the Northern California Cancer Center grant N01-PC-35136, University of Southern California grant N01-PC-35139, and Public Health Institute grant N02-PC-15105; the Centers for Disease Control and Prevention's National Program of Cancer Registries awarded to the Public Health Institute grant U55/CCR921930; the collection of metropolitan Detroit cancer incidence data was supported by the NCI SEER Program grant N01-PC-35145.

The ideas and opinions expressed here in are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.

Reprints: Steven J. Katz, MD, MPH, Division of General Medicine, University of Michigan Health Systems, 300 N. Ingalls, 7E10, Ann Arbor, MI 48109. E-mail: skatz@umich.edu.

© 2010 Lippincott Williams & Wilkins, Inc.