COMMUNICATION HOSPITAL EMR CANCER CARE PATHWAYS...

PREVENTIVESCREENING

INITIAL FP CONCERN/EXAM/PRESENTATION

CONTINUITY WITH FP

CANCER DIAGNOSIS BY FP TRANSITIONPREVENTION TRANSFER TO

PRIMARY CARELONG-TERM

CARECONFIRMED

SPECIALIST DIAGNOSIS

GENETICS CENTRE

EMERGENCY

ACUTE CARE

EMR

LABS

INTERNAL NETWORKSINTERNET TELEHEALTH

PATHOLOGY LAB

CANCER REGISTRY

INTERNAL MEDICINE

EMERGENCY

Practice EMR

Diagnostic CycleMedical

Test Results

Referral

LABLAB

RxRx

Referral

RxRx

Diagnosis

DxRx

Remission/Good outcome Biopsy

Investigations

Remission/Good outcome

Problematic outcome

Progression/Recurrence

PartialRemission

Discharge Cycle

End of Life/Hospice/ Home based Care

Skilled Nursing Home/

HOSPITAL EMR

INCIDENT ORSYMPTOM

Rural patients rely heavily on Primary Care for access to all applicable care needs.

PATIENT PORTAL

NP/Nurse RN/RPN/LPN

Family Physician

Oncology NurseGPO

Oncology Specialist

SurgicalOncologist

Oncology Nurse Nutritionist

GPOSurgical

Oncologist

Palliative Therapist

Patient Navigator

Palliative Therapist

Radiation Oncologist

OccupationalTherapist

Medication Advisor

Oncology Specialist

Family Physician

MedicalOncologist

TREATMENT AFTERCARE

REHAB

PRIMARY CARE PRACTICE

PERIDIAGNOSIS

DIAGNOSTIC INTERVAL

DIAGNOSIS SURVIVORSHIP

PRIMARY CARE TEAM

PALLIATIVE CARE

CANCER CARE SPECIALIST TEAM

MULTIDISCIPLINARY CANCER CARE TEAM

Community Clinic

Ambulatory Care

Genetics Centre

Investigations

Pharmacy

Family Practice

SECONDARYCARE PRACTICE

Radiology

Surgery

General Practice Oncology

Oncology Practice

Investigations

TERTIARYCARE

INFO TECH &COMMUNICATION

Cancer Surgery

Cancer Pain Clinic

Radiotherapy

Oncology

Labs & Imaging Mgt

Clinical Decision Support Tools

Hospital Websites

Patient Portal

EMR/EHR/PHR

COMPLEMENTARY& ALTERNATIVETHERAPIES

Homeopathy

Naturopathy

Ancient Healing Systems

Testing for Hereditary & Familial Cancers

50% Breast Cancer cases are screen detected and 50% through Primary Care

Breast Cancer patients adhere to Hormonal Treatment for 5-10 years.

About 20% Colorectal Cancer patients present symptoms first in Emergency.

Lab Tests/Radiology/ Mammogram orother diagnostic tests

43% visit ER due to adverse chemo reactions.

Care Planning

5% Breast Cancer patients get Neoadjuvant therapy.

Continuity of Care Plan

Surgery

Radiation

Hormone Treatment

Clinical Trials

Surveillance

Chemo

PsychosocialSupportive Care

ComplementaryPsychosocial Support

Support Groups/Religious Organizations

PsychosocialSupportive Care

Surveillance

Patient Population - Colorectal/Breast

InitialInvestigation

Burden onPatient

ReinforcingBehaviour

Symptoms

TrueDiagnosis

Inconclusive+ -

++-

-

TreatmentEffectiveness

End of Life Care

Reinforcing Limiting

Reinforcing Reinforcing

Survivorship

ChronicPopulation

Primary Care

FamilyPhysicians

MorePrimary

care

IncreasedPatient

Load

MorePrimary

care+

++

++

+

+

+

-

Increasing the effectiveness of Cancer treatment, grows the population of survivors, who live longer with manageable (but expensive) chronic illnesses.

Uncertainty in diagnostic interval can erode FP relationship with potential for adverse effect on survivorship.

CareAssistance

& ManagingComorbidities

The Clinical Map is a synthesis of findings across the modes of CanIMPACT research. It visually models the complex systems of care for breast and colorectal cancers, portraying the general processes of Canadian cancer care. The system map reveals salient clinical issues while aiming to express a sense of the system’s actual complexity.

The Mission: Enhance the capacity of community based primary healthcare clinicians to provide care to cancer patients and to improve the links between primary care and specialty providers.

35% Patients require

Psychosocial Support

10-12%On-going

psychosocial care

UNDERCONSTRUCTION

Telehealth could be asolution to preventingunnecessary travel formedical consultationswith Physicians

PRE DIAGNOSIS

PsychosocialSupport

CANCER CARE PATHWAYSIN CANADIAN HEALTHCARECANCER CARE PATHWAYS

IN CANADIAN HEALTHCARE

®

RESEARCH SYNTHESIS MAP

CANCER CARE PATHWAYSIN CANADIAN HEALTHCARE

Nurse/PatientNavigator

TREATMENT CONTINUITY STRATEGIES

Interoperable Electronic Communication& Information Systems EMR

LABS HOSPITAL EMR

Multidisciplinary Care Teams (Integrated Practice Units)

PsychosocialSupport

PREVENTION ANDDIAGNOSIS STRATEGIES

HealthSystemIntegration

EMR

LABS HOSPITAL EMR

PatientActivation

Health Promotion

SURVIVORSHIP STRATEGIES

Multicomponent initiatives

Interoperable Electronic Communication& Information Systems EMR

LABS HOSPITAL EMR

Nurse/PatientNavigator & Education

PhysicianEducation

Survivorship & PrimaryCare support to “unattached patients”

New Colorectal Cancer casesby provinces (2015)

25.1 KNew Breast Cancer casesby provinces (2015)

25.2 K

Lifetime probablity of Colorectal Cancer

M: 1 in 14F: 1 in 16

Colorectal Cancer

Breast Cancer

9200

9800

Lifetime probablity of Breast Cancer

High continuity more likely to be screen-detected

High comorbidity less likely to be screen-detected

F: 1 in 9

25% (MB)28% (AB)25% (MB)28% (AB)

Rural ON & MB more likely tobe screen-detected than urban.

to25% (MB)28% (AB)

7-13%7-13%7-13%

Screen Detected

28 days28 daysscreen-detected

symptom-detected

28 days

34 days34 days34 days

Median Diagnostic Interval

ONONONON immigrants

less likely to be screen-detected

Ontario BreastScreening Program

DiagnosticAssessment Program

Colorectal Cancer

Breast Cancer

970

860

MBMBMBColorectal Cancer

Breast Cancer

920

780NSNSNS Nova Scotia Breast

Screening ProgramLEAN on cME

19 days19 daysscreen-detected

symptom-detected

19 days

21 days21 days21 days

Median Diagnostic Interval

ABABABComprehensive Breast Care Program

Clinical BreastHealth Program

eReferral

Colorectal Cancer

Breast Cancer

3150

34007-13%7-13%7-13% 30 days30 days

screen-detected

symptom-detected

30 days

30 days30 days30 days

Median Diagnostic IntervalBC immigrants

less likely to be screen-detected

BCBCBCColorectal Cancer

Breast Cancer

6600

6100

CANADACANADACANADA Colorectal Cancer

Breast Cancer

2160

2300

QCQCQC

Colorectal Cancer

Breast Cancer

120

110PEIPEIPEI

Colorectal Cancer

Breast Cancer

560

360NLNLNL

Colorectal Cancer

Breast Cancer

770

710SKSKSK

CancerRelated Agencies & NGOs

Canadian Partnership Against Cancer

Canadian Cancer Society

Canadian Breast Cancer Foundation

Clinical Colleges

Colleges of Physicians,Surgeons, Nursing

Canadian College of Family Physicians

Licensing Bodies, Professional Standards & Certifiers

Communities Faith Communities &Congregations

Community groups

Voluntary Sector

Foundations

Support Groups

Individuals& Families

Persons as Patients

Family Members

Friends & Social Circle

National Policy & Governance

Canadian Task Force on Preventive Health Care

Federal Ministry of Health

Canadian Institutes of Health Research (CIHR)

Provincial& Territorial

Ministries of Health

Provincial Cancer Agencies

Provincial Health Regions or Districts

Regional Cancer Programs

Ontario Institute for Cancer Research

STAKEHOLDERSCanIMPACT Research Team

Contributorsto the map

Eva Grunfeld, Univ of TorontoGeoff Porter, DalhousieJonathan Sussman, McMasterJulie Easley, Dalhousie June Carroll, Univ of TorontoPatti Groome, Queen’sBo Miedema, DalhousieSharon Matthias, EdmontonMary Ann O’Brien, U of TorontoMarg Fitch, Univ of Toronto

Patient Advisory Committee

Marg Fitch, Co ChairSharon Matthias, Co Chair Dawn PowellJulie EasleyNancy SchneiderMargaret TompsonCatarina VersaevelBonnie VickRichard Wassersug

OCADUsLab Team

Peter JonesPrateeksha SinghSmriti Shakdher

Legend

Type of Care

Clinical Role in Journey

Clinical Process/Workflow

Primary Care Stages

Colorectal Cancer Patient Flow

Breast Cancer Patient Flow

Typical Cancer Patient Flow

Info Tech & Communication

Secondary Care Practice

Primary Care Practice

Tertiary Care

Recommendation

Cancer Clinical Flow

Cancer Stages

Other Flows

Facts & Statistics

Qualitative Research Information

Copyright (c) 2016 Strategic Innovation Lab, OCAD University