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 MedicineCancer Survivors in Primary Care: EnvironmentalAttributes for Success in Patient-Centered MedicalHomesAutumn 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 Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtKieber-Emmons, A., Miller, W., Crabtree, B. (2015, October 24). Cancer Survivors in Primary Care: Environmental Attributes for Successin Patient-Centered Medical Homes. Poster presented at: NAPCRG, Cancun, Mexico.1Lehigh Valley Health Network, Allentown, PA, 2University of South Florida Morsani College of Medicine, 3Department of Family Medicine and Community Health, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJCancer Survivors in Primary Care: Environmental Attributes for Success in Patient-Centered Medical HomesAutumn M. Kieber-Emmons, MD, MPH,1  William L. Miller, MD, MA,1,2  Benjamin F. Crabtree, PhD3Successes in diagnosis and treatment of cancer have resulted in dramatic increases in the number of long-term cancer survivors, many of whom are being cared for predominantly by primary care. It is unclear what environmental and contextual attributes of new Patient Centered Medical Homes (PCMHs) allow for optimal care for these complex patients. © 2015 Lehigh Valley Health NetworkBACKGROUNDAcknowledgements:This research was supported by grants R01CA176545 and R01CA176545-02S1 from the National Cancer Institute.References:1.  Ganz PA. Survivorship: adult cancer survivors. Prim Care. Dec 2009;36(4):721-741.2.  Ogle KS, Swanson GM, Woods N, Azzouz F. Cancer and comorbidity: redefining chronic diseases. Cancer. Feb 1 2000;88(3):653-663.3.  Sunga AY, Eberl MM, Oeffinger KC, Hudson MM, Mahoney MC. Care of cancer survivors. Am Fam Physician. Feb 15 2005;71(4):699-706.This study is examining environmental and contextual attributes of the local community, medical neighborhood, and policy neighborhood that help or hinder successful cancer survivorship care in the primary care setting. OBJECTIVEDesign:Health Policy Analysis of contextual elements of communities, medical networks and policy environments that impact cancer survivorship care in primary care. This analysis is embedded within a large NCI-funded comparative case study evaluating PCMH implementation strategies across the country, comparing exemplar practices guided by NCQA recognition versus those in which innovation is the guided principle. Data Sources:Mixed methods health policy analysis, with data collected from field interviews with key stakeholders, alongside literature/Internet review and GIS mapping of practice regions. Settings:National purposeful sample of 7 exemplar PCMHs that include a diverse mix of states, medical networks, and policy environments. NCI grant includes future research using immersion/crystallization technique to identify 13 additional practices to include as case comparisons, highlighting additional elements of diversity of communities, medical networks and regional policy differences.Participants:Patients with a history of cancer, primary care physicians, healthcare professionals, and office staff. Key stakeholders to be interviewed in the coming months include community members, medical network administrators, oncologists, legislators and insurance administrators. Qualitative Analysis:~96 key stakeholder interviews transcribed, Atlas.ti, qualitative analysis of data to create 20 discrete case descriptions of practices, with a focus on community, medical and policy neighborhood attributes that influence cancer survivorship care.Quantitative Analysis:Develop 20 case studies with descriptive statistics, do comparative statistical analysis of case study practice regions against practices across the country to determine factors that may be influencing cancer survivorship care in exemplar practices.METHODSDISCUSSIONNext Steps: Identify and recruit key stakeholders from each of the three neighborhood levels: Community Key Stakeholders, Medical Network Key Stakeholders, Policy Environment Key Stakeholders. Qualitative 30-45 minute unstructured interviews with key stakeholders for content related to how cancer survivorship is provided in the primary care settingPractice Selection: Of the 7 practices that already participated in the parent research on-site evaluation, the preliminary analysis shows some limitation in range of diversity across patient demographics, payer type, practice type and political state context. The next round of practices to be included for on-site study have been specifically chosen to expand on these variables and include greater diversity of:       Patient Demographics, Payer Mix, Medicaid Expansion State, Large Health Systems, Politically Supportive State, Medicare Shared Savings Model, Direct Care and Nurse-led ModelsCONCLUSIONSCancer Survivors are becoming increasingly more common among primary care patients. Through this health policy analysis, we aim to uncover any specific community, medical and policy neighborhood elements across the country that aid or hinder the delivery of high-quality cancer survivorship care within examplar PCMHs. Particular attention will be taken to address whether community resources, oncology-PCP collaboration and policy/insurance regulation environments could provide sufficient inertia to allow for the delivery of high-quality cancer survivorship care within the primary care setting.Environmental and Contextual Elements of Three Layers of Neighborhood that Affect Cancer Survivorship Care in a PCMH. RESULTSMixed Methods Approach: Three Layers of Neighborhood evaluation of environmental and contextual attributes aiding or hindering cancer survivorship care in PCMHs.

Cancer Survivors in Primary Care: Environmental Attributes for Success in Patient-Centered Medical Homes

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1278&context=family-medicine

Cancer Survivors in Primary Care: Environmental Attributes for Success in Patient-Centered Medical Homes

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