Julie Kuznetsov: Designing a new model for cancer care that radically improves value

Описание: Our team at Stanford’s Clinical Excellence Research Center used design principles to develop a model that radically increases patient value in cancer care — defined as improving patient-centered outcomes (e.g., survival, quality of life during treatment, experience of care) while decreasing costs to achieve them. We utilized an innovative healthcare delivery redesign method developed at Stanford , used to create multiple care models implemented at health systems across the US.

Observations and interviews with patients and providers were conducted at 3 US cancer sites using human-centered design methods from Stanford’s dschool and Biodesign Program. Sites were selected based on claims data and nationally reported oncology quality metrics (Quality Oncology Practice Initiative (QOPI), and ASCO’s Choosing Wisely) to include both those that performed in the top quartile for quality and cost and an average-performing comparator. Site visits were complemented with a review of literature and expert consults on value improvement for cancer, oncology practice, health and behavioral economics, and an analysis of “adjacent possible” medical conditions and industries. An additional 4 academic medical centers were visited to observe exemplary performance on one or more of the areas of opportunity for improving value. From this, we used an iterative design process to 1) identify the key features of care teams performing at the current value frontier; and, 2) incorporate these features into a scalable cancer model that eliminates the use of medical services of little, no, or even negative value to patients.

A key finding in part 1 was that an integrated multidisciplinary team (IMT) provides the foundation for high value care. Best in class sites offered patients multidisciplinary evaluation, a clearly outlined treatment plan based on protocols affirmed by all care team members, feedback loops to improve care, a patient “captain” across the care continuum, 24×7 access to the clinical team, and co-located specialists with disease-specific expertise. Hand-offs at these sites are smoother since patients and specialists reference the same clear plan. In comparison, lower-performing sites struggled with fragmentation, poor care coordination, gaps in care, delayed care, and duplicated or even harmful medical interventions.

In part 2, we translated the most impactful aspects of IMTs to a scalable care model that could be implemented in a variety of local contexts. These include: 1) clearly outlined treatment plan based on protocols affirmed by all care team members, 2) feedback loop to improve care, and 3) an approximation of team co-location through financial, administrative and social tools that foster shared accountability for patients’ well-being.

Our forecasts suggest that this IMT model will preserve survival benefits by improving guidelines-concordant cost-conscious treatment delivery, better addressing symptoms and side effects of treatment that lead to unplanned hospitalizations, and demonstrate the potential to decrease national spending on cancer care by 12-15% ($21-26B) by removing wasteful spending.