Crabtree, Benjamin F, PhD

Kieber-Emmons, Autumn, MD, MPH

Miller, William L, MD, MA

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksDepartment of Family MedicineMixed methods health policy Analysis of CancerSurvivorship within Primary Care: Insights andPerspectives for Improving CareAutumn Kieber-Emmons MD, MPHLehigh Valley Health Network, Autumn.Kieber-Emmons@lvhn.orgWilliam L. Miller MD, MALehigh Valley Health Network, william.miller@lvhn.orgBenjamin F. Crabtree PhDFollow this and additional works at: https://scholarlyworks.lvhn.org/family-medicinePart of the Medical Specialties CommonsThis Presentation is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works byan authorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtKieber-Emmons, A. Crabtree, B. Miller, W. (2016 Nov). Mixed methods health policy Analysis of Cancer Survivorship within PrimaryCare: Insights and Perspectives for Improving Care. Presentation presented at: NAPCRG Annual Meeting, Colorado Springs, Colorado.MIXED METHODS HEALTH POLICY ANALYSIS OF CANCER SURVIVORSHIP WITHIN PRIMARY CARE: INSIGHTS AND PERSPECTIVES FOR IMPROVING CAREAutumn M. Kieber-Emmons, MD, MPHWilliam L. Miller, MD, MABenjamin F. Crabtree, PhDNov. 13th, 2016Background:• Over 14 million cancer survivors in the United States and the number is rapidly growing• Unclear role for Primary Care in cancer survivorship care • Conflicting definitions of survivors, survivorship care, guidelinesObjective:• To determine contextual, environmental and policy features that may be hindering or improving the provision of high-quality cancer survivorship care nationally Design• Mixed Methods – Concurrent Triangulation • Comparative Case Study• Health Policy Analysis * Embedded NCI funded supplement within larger NCI funded R01 national case comparative study of cancer survivorship within Patient-Centered Medical HomesSocio-ecologic Framework• Evaluating Contextual/Environmental Features of Cancer Survivorship from Three Levels:• 1) Community Neighborhood • Social demographics of community, access to community health resources, cancer resources, support groups• 2) Medical Neighborhood• Primary care clinicians, oncology providers, health systems, lab/radiology services, cancer centers, referral patterns, survivorship clinical sites• 3) Policy Neighborhood• ACO or provider regional networks, insurance market and regulations, financial metrics in region, DOH inputMixed Methods Design• Quantitative Geospatial Mapping • Key Variables of interest for social determinants of health• Mapping for Primary Care clinicians, oncologists, mental health providers and health facilities• Qualitative Analysis • Analysis of field notes, patient pathways, practice interviews from R01 parent study • Key informant Interviews, 45 min telephone depth interviews • Cross Comparative Analysis between informants at different layers and across informants of same layer from different regionsKey Informant Interviews • Community Informant • Examples: Community resource CEO, community researcher, AHEC representative, community board member specific to health)• Medical Informant • Examples: Medical Director of health system, administrative and clinical leaders of health provider network, key oncologists from referral network, director of cancer center• Policy Informant• Examples: Insurance company leaders, local or state department government officials, regulatory board members Descriptive Case Study – P3• Practice #3 from NCI R01 Parent Grant is located in Erie County, NY• Mixed methods health policy analysis for supplement was undertaken for Erie CountyMapping of Oncologists in Erie CountyQualitative Analysis • Identification of first three key informants to interview:• 1) Community Neighborhood– Community Health Disparities Researcher• 2) Medical Neighborhood – Administrative Leader of IPA• 3) Policy Neighborhood – CEO of Insurance Company serving region  Interview Transcript Analysis: Medical NeighborhoodFinancial viability is a strong driver in new initiatives As the leader of the IPA, his viewpoint is based on the healthcare market and he chooses what the IPA focuses on based on its ability to control cost while improving care, i.e. the triple aim framework. The bottom line is that since cancer survivorship care hasn’t been shown to reduce costs, it is unlikely to gain traction as an initiative in this IPA.The oncology-primary care relationship needs to be strengthened for cancer survivorship care to be implemented.The adult oncology-primary care relationship is weak. Incentives for better collaboration through the ACO and PCMH give reason to be hopeful that there may be improved collaboration in the future. As a pediatrician, he feels that “childhood cancers” are an anomaly; for a variety of reasons, pediatric primary care doctors and specialists provide better cancer survivorship care.Cross Comparison of ThemesThree Take-Aways1) Guidelines and Metrics are Important, Currently there is a lack of guidelines for cancer survivorship and there are challenges to implement guidelines available2) Need improved PCP-Oncology Relationship and Coordination 3) Lack of National Survivorship Care Focus, Ways to Advance the Agenda Acknowledgments• Thanks to my mentors, Dr. Benjamin Crabtree and Dr. William Miller• NCI Funding – NIH 3R01CA176545-02S1 • Rutgers Crabtree/Hudson Research Teams• Sub-group Analysis Co-Members – Dr. Jenna Howard, Dr. Jennifer Tsui• Robert Graham Center/Health Landscape, Dr. Jennifer Rankin for contribution with mapping components of studyautumn.kieber-emmons@lvhn.orgExtra Slide – Tabular Data Erie CountyInterview Transcript Analysis: Medical Neighborhood

Mixed methods health policy Analysis of Cancer Survivorship within Primary Care: Insights and Perspectives for Improving Care

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Mixed methods health policy Analysis of Cancer Survivorship within Primary Care: Insights and Perspectives for Improving Care

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