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Care Network Coordination for Chemotherapy at Home: A Case Study
11th IFIP Working Conference on VIRTURAL ENTERPRISES
(PROVE’10) 1113 October, 2010 SaintEtienne, France
Tian Zhang 1 , Eric Marcon 1 , Maria Di Mascolo 2 1 LASPI, Jean Monnet University – St Etienne, France
2 GSCOP, INP – Grenoble, France
2
Background
q Cancer chemotherapy : 83% in day hospitals
q Rapid development of chemotherapy at home (15,6% in 2006)
q Threeday patient tr eatment pr ocess
Cure validation ( Green light)
Medicines preparation
Production of chemo. drugs
Chemotherapy drugs delivery
Hospital
Cure reprogrammation
Pr imary medecine
End of cure
D1 D
Nurse
Care str ucture (HCS or Cancer
network)
D+1
Blood sample collection
Blood analysis
Chemotherapy administration
Followup after chemotherapy
Biological laboratory Physician
Pharmacy
Medicines preparation
Pharmacy
Nurse Nurse Logistician or external transporter
No
Yes
Background
q Realworld case study • HCS structure situated in RhôneAlpes province in France
• Beginning of the chemotherapy at home activity in the 90’s
• Chemotherapy at home = 3% of patient admissions
Threephases process modelling
Public hospitals
• Agreement of hospital
• Agreement of patient
• Agreement of the HCS structure
• Home visit
• Treatments planning
• Information to care actors
• Logistic planning
• Chemotherapy cure realization at home
Patient admission phase Preparation phase Realization phase
4
q Realization process of chemotherapy at home
Problem setting
Hopital City
D1
D
Soins et Santé
D+1
Blood sample collection
Biological analysis
validation of cure (Clinical Green Light –
CGL) validation of cure (Final Green Light – CGL) Validation &
Medicines preparation
Chemo. Drugs
production
Chemo. drugs delivery
Chemotherapy administration
Followup post chemotherapy
Nurse coordinator
Doctor coordonator Transporter Private nurse Family doctor
Biological laboratory Pharmacy Pharmacy
Coordination D1 & D
5
q A chemotherapy at home system managed by a coordination center
Problem setting
Nurse coordinator
External actors
Private nurse
Biological laboratory
Family doctor
Hospital pharmacy
Coordinate
Verify, Inform and Press (by phone or fax)
Efficient and good quality coordination ???
A good and smooth organization depends greatly on quality of coordination
• Evaluate the quality of coordination of the studied system
• Propose improvement schemes
6
Method and Results
qMethod and approach • Discreteevents simulation (Software Rockwell ARENA)
• Current system (Scenario 1) => Redefinition of coordination design (Scenario 2) => Use of a traceability management system (Scenario 3)
q Elements of simulation model • From 0 to 4 patients per day
• 7 chemotherapy protocols
• 2 public hospital pharmacies
• Intervention area : 80 km around the studied HCS structure
• Simulation of two first days of the process with a 3 months’ experiment period
q Per formance indicators • Coordination time
• Impact of coordination design on chemotherapy at home organization
7
Method and Results
q Scenario 1 – Current system
Coordination design: Nurse coordinator takes the initiative to communicating with external actors
• Verify activities execution
• Transfer information
• Press them in case of forgetfulness, mistakes and delays
Simulation scenar ios descr iption
8
Method and Results
q Scenario 2 – Redefinition of coordination design
Nurse coordinator
External actors
Private nurse
Biological laboratory
Family doctor
Hospital pharmacies
Step 1.
Inform
(Receipt and transfer information)
Step 2.
Redefinition of actor s’ r esponsibility Cut of r edundant activities
CGL FGL
HCS pharmacy Hospital pharmacy
9
Method and Results
q Scenario 3 – Use of a traceability management system
Cable network
Mobile network
Method and Results
q Comparative analysis
Coordination time (minute)
47
32
18
0
10
20
30
40
50
Coordination time (minute)
Coordination time (minute) 47 32 18
Scenario 1 Scenario 2 Scenario 3
Method and Results
q Comparative analysis
Activ ity execution time (minute)
169 165
55
253
187
97
0
50
100
150
200
250
300
Scenario 1 Scenario 2 Scenario 3
Biological laboratory Family doctor
Delays of realization
27%
5%
0%
28%
5%
0% 0%
5%
10%
15%
20%
25%
30%
Scenario 1 Scenario 2 Scenario 3
Biological laboratory Family doctor
12
Conclusion
q Study of chemotherapy at home system • Work based on a realworld study
• Process modelling
• Performance evaluation in terms of quality of coordination
q Proposition of improvement schemes • Two propositions : redefinition of the coordination design and use of a traceability management system
• Traceability management system = the best solution for quality of coordination improvement