Search

Background: Transitioning low-risk cancer survivors back to their primary care provider (PCP) has been shown to be safe but the effect on health system resources and costs has not been examined. Methods: A Well Follow-Up Care Initiative (WFCI) was implemented in the publicly funded health system. Low-risk breast cancer (BC) survivors in the WFCI intervention group were transitioned from oncologist-led cancer clinics to PCPs. We compared health system costs ($2,014 in Canadian dollars) and resource utilization in this intervention group with that in propensity-score–matched nontransitioned BC survivors (ie, controls) diagnosed in the same year, with similar disease profile and patient characteristics using publicly funded administrative databases. Results: A total of 2,324 BC survivors from the WFCI intervention group were 1:1 matched to controls and observed for 25 months. Compared with controls, survivors in the intervention group incurred a similar number of PCP visits (6.9 v 7.5) and fewer oncologist visits (0.3 v 1.2) per person-year. Fewer survivors in the intervention group (20.1%) were hospitalized than in the control group (24.4%). There were no differences in emergency visits. More survivors in the intervention group had mammograms (82.6% v 73.1%), but other diagnostic tests were less frequent. There was a 39.3% reduction in overall mean annual costs ($6,575 v $10,832) and a 22.1% reduction in overall median annual costs ($2,261 v $2,903). Overall survival in the intervention group was not worse than controls. Conclusion: Transitioning low-risk BC survivors to PCPs was associated with lower health system resource use and a lower annual cost per patient than matched controls. The WFCI model represents a reasonable approach at the population level to delivering quality care for low-risk BC survivors that seems to be cost effective.

39 Background: In Ontario’s publicly funded cancer system, patient access to Gynecological Oncology (GyneOnc) care is threatened by growing demand, waiting times and need for lengthy patient travel. Cancer Care Ontario has published organizational standards that lay out the minimum clinical elements and infrastructure needed for a high quality program. Capacity planning and readiness assessments were used to guide GyneOnc expansion into non-academic regional cancer centres to alleviate system pressure. We evaluated early expansion activities to learn about critical factors and generate recommendations for future growth of this specialized oncology service. Methods: Capacity planning for new centres factored health human resources (HHR), patient volume and travel distances, ensuring that existing programs maintain critical mass. Evaluation included review of documents and readiness assessments related to the expansion projects undertaken to date. Interviews were done with GyneOncologists and administrators working at local and provincial levels to discover areas of risk, key factors for success, and recommended strategies for future expansion. Results: Gyne Onc programs need adequate resourcing (minimum 3 GyneOncs) to meet patient demand, support on-call and offer resilience to parental/medical leaves. Programs need engagement from other surgical and medical subspecialties, and clinical services (e.g. pathology, diagnostic imaging) for integrated, multidisciplinary care. Academic appointments, residencies, fellowships, and support for research provide links with universities, important for credibility. Endorsement by senior leadership - both management and clinical - is crucial. Organizational standards need specificity around the infrastructure and multidisciplinary environment needed for program success. Conclusions: HHR planning and readiness assessment are critical enablers in the expansion of specialized services like GyneOnc beyond academic centres. New programs need to consider the adequacy and appropriateness of staffing models, broad engagement of the clinical team, and linkages to academia, in order to ensure program sustainability and acceptability.

1 Background: The provincial cancer agency in Ontario developed and implemented a model of care (MOC) for breast cancer (BC) survivors to transition from oncology-lead care to primary care in a publically funded health care environment (2010-2013). Transition options included direct to primary care and stepped transition. The objective of our study was to examine the health system resources used by the women in the MOC group and compare them to those used by women who did not transition. Methods: A propensity score matched, quasi-experimental approach was used to compare the healthcare resource utilization and costs between BC survivors in the MOC program (case) and those receiving usual care (control). All MOC cases were linked using unique identifiers and linked into the provincial health system databases. Cases and controls were matched 1:1 on year of diagnosis and location of care and were followed from an index date to the earliest of her death date, date of last contact in the database, one day before another cancer diagnosis or the end of study available databases. The primary study outcome was overall health system utilization and mean cost during the follow-up period. Results: There were 2324 women in the MOC program. Demographic information (age, region, stage) were well balanced between cases and controls. Transitioned cases had lower hospitalizations (20.1% vs. 24.4%, p

115 Background: For many patients going through diagnostic testing for cancer, the time from suspicion to diagnosis or rule-out, can be a confusing and anxious time. In 2007, Cancer Care Ontario began investing in the implementation of diagnostic assessment programs (DAPs) across Ontario, Canada to improve the quality of care during the diagnostic phase of lung cancer. DAPs consist of multidisciplinary healthcare teams that manage and coordinate a patient’s diagnostic care from testing to a definitive diagnosis. The objectives of the DAPs are to: 1) decrease time from suspicion to diagnosis or resolution; 2) optimize the patient’s experience during the diagnostic process; 3) optimize satisfaction and experience among primary care providers and specialists; and 4) provide a sustainable solution by offering good value for money. Today over 35,000 patients have been diagnosed in one of the 18 lung DAPs that exist across the province. Methods: The implementation of DAPs featured the introduction of a patient navigator to act as the primary point of contact for patients, improve the patient experience and ensure their patients were progressing through any required diagnostic imaging and consultations in a timely manner. Cancer Care Ontario also engaged with primary care providers to refer patients with findings suspicious for lung cancer to DAPs as early as possible to ensure they benefited from organized assessment. Cancer Care Ontario has collected patient level data to measure wait times and implemented a patient survey to assess patient experience. Results: In the past five years, the median wait time from referral to a lung DAP to diagnosis or rule out has decreased by 19% to 24 days and the 90th %tile has decreased by 28% to 51 days. The large majority of patients have had a positive experience with their DAPs, with 95% of patients scoring their experience in the diagnostic process as “good” or “excellent”. Conclusions: The implementation of DAPs across the province is seen as a valuable component of quality of care by improving the diagnostic phase of cancer. The sustainability of the DAP model is demonstrated by the continued improvements in access and maintained patient experience in spite of growing volumes (91% increase in the past five years).

118 Background: The True NTH Initiative aims to improve the lives and experiences of men with prostate cancer, as well as those of their partners, family and caregivers. In Canada, Prostate Cancer Canada selected ten teams to develop, implement and evaluate evidence-informed programs focusing on decision support, clinical support, lifestyle management, education, social support, navigation and treatment follow-up. Project teams were encouraged to align their local evaluations with a common evaluation framework and a national evaluation plan was developed. The aim of this abstract is to share methodology and early results of a multi-level evaluation that will address a range of programs designed to improve the lives of men with prostate cancer. True NTH is funded globally by the Movember Foundation, and operates in Canada, USA, UK, Australia, New Zealand, Ireland and Singapore. Methods: Projects (Solutions) selected for the initiative had existing evidence for their efficacy. Project teams were responsible for designing the implementation of their Solution and an appropriate evaluation. Local and national evaluations used a recognized framework (RE-AIM) to systematically study the real world uptake of these interventions, focusing on questions of Reach, Effectiveness, Adoption, Implementation, and Maintenance. Project teams provide quarterly narrative updates and annual written reports with quantitative measures and narrative components. Key informant interviews with project leads will complete the final national evaluation. Results: To date, projects have generated learning across different provincial health systems, academic institutions and community settings. Teams have learned to address challenges of participant recruitment and project endorsement, and have begun to appreciate the benefits of collaboration. Teams have also reflected on the importance of engaging clinicians in the implementation of their Solutions for effective uptake and sustainability. Conclusions: The results of the ongoing multi-level evaluation continue to provide insight into real world implementation of evidence-informed programs and the critical factors that enable their effectiveness.

305 Background: For many patients going through the cancer diagnosis journey, the time from suspicion to diagnosis or rule-out can be a confusing and anxious time. To better support patients during this time, Cancer Care Ontario (CCO) is supporting Diagnostic Assessment Programs (DAPs) and the web-based tool known as the Diagnostic Assessment Program–Electronic Pathway Solution (DAP-EPS). DAPs consist of multi-disciplinary healthcare teams who provide diagnostic and supportive care services in a patient-focused environment, improving access to care and the patient experience. DAPs help manage and coordinate a patient’s diagnostic care from testing to a definitive diagnosis and part of this support involves providing access to personal health information through the DAP-EPS. This work was undertaken to determine the best approach to sharing test results with patients, including the type of test results that should be released and the most effective method for sharing these results with patients, from both the patient and provider perspective. Methods: The exploratory project involved conducting key informant interviews with individuals who had been involved with implementing similar patient portals, a targeted literature review, and a series of engagement sessions with physicians to measure the clinical response to this new strategy. Results: Initial discussions with patients and nurses yielded a strong endorsement for releasing all results, with no time delay. Key Informant interviews yielded similar results from the majority of the hospital contacts consulted. The environmental scan did not suggest that releasing results was associated with any adverse patient or provider effects. The physician engagement sessions generated both positive and negative feedback but overall, doctors were comfortable releasing all results, provided there was a delay built into the system. Conclusions: The release of diagnostic test results is seen as a valuable component of quality of care from the perspective of informing and empowering the patient. As the DAP-EPS moves forward with this initiative, the DAP program will continue to monitor the impact that the release of results has on both patients and providers.

5 Background: Patients frequently have a difficult time finding their way through the process of diagnostic testing for cancer; the uncertainty is stressful and anxiety can impede effective communication and decision-making. Patient navigation is an ideal approach to supporting patients during the diagnostic phase of cancer care. Methods: Between 2010 and 2011, 14 Patient Navigators were trained and introduced into Diagnostic Assessment Programs (DAPs) across Ontario. DAPs are designed to provide coordination and supportive care to patients undergoing diagnostic testing and assessment. A patient survey served to evaluate the impact of patient navigation on the patient experience. Standardized tools were introduced to measure symptom severity and symptom management. Interviews were done to gauge provider and team perspectives on the role. Results: During the pilot, patient symptoms improved in the areas of well-being, tiredness, anxiety and shortness of breath, each by 30% or more. The patient survey indicated that through the program, patients got the information and support they needed; 91% of patients surveyed said that they were either satisfied or very satisfied with their experience with the patient navigator. The navigation pilot sites saw their diagnostic wait times fall by 55%. The Patient Navigators have found their work to be highly satisfying and rewarding, enjoying the opportunity it provides to use their full scope of practice in a multidisciplinary environment. Physicians expressed a high degree of satisfaction with the support provided by the Patient Navigators, reporting that patients were better prepared and informed when they arrived for their clinic appointments. Conclusions: This work has shown that patient navigation enhances the experience of patients as they move along the diagnostic continuum. Patient Navigators assist patients with managing their physical and psychosocial symptoms and play a critical role in providing the information and support patients need during a time that is full of uncertainty and distress. The diagnostic phase is a prime example of where navigation can have an impact on both the quality of patient care and the effectiveness of the health care team.

9621 Background: The morbidity of patients with cancer would be significantly reduced if they received optimal symptom management. This requires early identification of the symptoms, comprehensive ...