Project 2: Care Integration for Patients with Cancer Treated in Independent Practices

PROJECT SUMMARY/ABSTRACT: Project 2 - Care Integration for Patients with Cancer Treated in Independent Practices The goal of this Project is to describe care integration for patients with cancer treated in independent oncology practices and to identify forms of care integration associated with better quality and outcomes. Many cancer

patients are treated by medical oncologists in independent practices. Their clinicians must deliver high-quality care while also coordinating care across different types of clinicians (e.g., surgeon, radiation oncologist, pharmacists) and multiple settings (e.g., office, pharmacy, hospital, post-acute care and hospice). Medical

oncologists have key roles in patients’ initial evaluation, treatment initiation, coordination of multidisciplinary treatment, survivorship care, and palliative and end-of-life care. Project 2 will describe key forms of care integration for medical oncology practices (structural, normative, functional, interpersonal, and process) and

assess relationships of different forms of integration with one another (e.g., extent of structural integration with strength of interpersonal integration) and with outcomes demonstrating integrated care for patients. Working with Projects 1, 2, and 4 and the Cores, the team will conduct case studies to learn about mechanisms by

which independent oncology practices achieve care integration and to adapt and tailor measures of integration to oncology care. The team will survey practice leaders, managers, clinicians, staff, and patients from a representative sample of independent practices to measure various forms of integration. Using administrative

data from Medicare, Medicaid, and commercial insurers, the team will measure key outcomes (including quality of care, utilization, and spending) and examine relationships between these outcomes and various forms of integration. At each step in the investigation, we examine how integration relates to care delivery and

outcomes for historically marginalized subgroups. Project 2 aims mirror the overall Project aims: Aim 1: Adapt an existing framework and measurement concepts to describe key forms of integration beyond structural (i.e., functional, normative, interpersonal, process) for oncology care delivered in independent

oncology practices using case studies and interviews. Identify mechanisms through which forms of integration may yield improved and more equitable patient care and better outcomes. Aim 2: Measure care integration in independent practices and assess relationships among different forms of care integration. Determine how and whether these relationships vary by practice and market factors.

Aim 3. Assess the association of each form of integration with utilization, spending, and high-quality and equitable care delivered in independent oncology practices and assess mechanisms through which integration improves or worsens overall outcomes and equitable care for marginalized subgroups. Defining and assessing how independent practices integrate oncology care and how clinicians and patients

experience care integration across the cancer care continuum and understanding how integration is associated with important outcomes will inform policies and practices that improve patient outcomes.