Improving Care Coordination in Regional Oncology Care Pathways

Abstract

Background: A shift in the organisation of oncology care towards collaboration between hospitals in oncology networks (CCNs) is observed to allow high-quality, accessible, and affordable care in the future. The collaborating hospitals align their care processes and design a joined regional care pathway (RCP) to standardise and structure their care. Within an RCP the patient is transferred between hospitals in the CCN, often for specialised and complex care like surgery.

Problem statement: The various disciplines and institutions involved in care delivery ask for coordination of care, clear agreements, and proper handovers of tasks. Inter-organisational collaborations within a CCN introduce new challenges (e.g. in information exchange) regarding coordination compared to multidisciplinary intra-hospital collaboration, because organisational and geographic boundaries are crossed. Unfortunately, little is known about how coordination between collaborating hospitals in a regional oncology care pathway can or should be achieved. Therefore, this thesis aims to contribute by developing a framework guiding improvements in coordination for RCPs.

Methods: A mixed-method approach was used which included a literature search and semi-structured interviews with healthcare professionals in oncology networks, policymakers, and patients. A selected conceptual framework of care coordination was adapted based on literature and each aspect within the framework was defined. Additionally, evaluation measures and improvement actions for each aspect were identified. The interviews were used to elaborate the findings from literature and incorporate the right context for RCPs. Moreover, the interviews gave insights into the experienced challenges and best practices. Lastly, the developed framework was applied in a case study.

Results: The framework for Care Coordination in Chronic and Complex Disease Management was opted as an initial conceptual framework and was extended by three additional aspects identified by other studies. The framework categorises the aspects of care coordination in domains creating an overview of the relation of each aspect in the coordination processes. The interviews resulted in two extensions of the original framework: 1) Alignment of resources and processes besides cultural alignment; and 2) leadership/coordination at the network level besides the boundary-spanning role of the case manager at the patient level. All aspects of the framework fit the RCP context, although some overlap between the aspects was identified.

Conclusion: The framework supports hospitals in improving coordination between hospitals within the RCP by offering an overview of aspects, evaluation measures and improvement possibilities. Information exchange, communication, and clear RCP protocols with defined roles and responsibilities turn out to be important aspects that facilitate coordination. These should be supported by boundary spanning actions and emergent conditions, like personal relationships and trust. Especially organising digital exchange of patient information is important for CCNs, but is still challenging to establish. A well-designed monitoring system including reminders and alerts will support coordination. However, regional dashboard development is challenged by non-structured data and differences in data structures between the hospitals. To further scale up initiatives for larger challenges and more resourceful improvement initiatives (e.g. digital exchange of EMR data), close collaboration within and between CCNs, and exchange of knowledge, tools, and best practices should be established.