Upload
vodan
View
213
Download
1
Embed Size (px)
Citation preview
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