Pediatric Oncology Clinic Care Model: How to Care for Patients to Achieve Better Continuity of Care in a Medium Sized Program

Introduction: Providing effective outpatient care to oncology patients is the goal of all programs. There are two potential models of providing this care, a primary physician model which is the model generally employed by large oncology programs, and a team based model which is the model employed by small oncology programs. Medium sized programs (defined as 50-100 newly diagnosed patients per year), face a challenge as to what the best model of oncology outpatient care is to follow given the number of oncologists providing clinical care. We attempted to develop a hybrid model of team based and primary physician model in order to improve care of patients at our medium sized center.

Methods: Prior to making any changes from the longstanding team based model of outpatient care, a patient satisfaction survey was conducted. Multiple meetings were held with the physician group to discuss the current model of care (team based model) and the potential ways to change the model given the complexity of patients and protocols. After much discussion it was decided that all patients would have a dedicated oncologist. There would then be two types of weeks of clinical service in the outpatient clinic. The first type was a “Doc of the Day” week where each oncologist would have a specific day in clinic and their assigned patients would be booked to come to clinic on those days. The second type was a “Doc of the Week” week where one physician would be attending in clinic for the week. There would be a 1:1 ratio of the two types of weeks. During vacations or holidays the week would be designated “Doc of the Week”.

Results: The patient satisfaction survey done prior to changing the model of care showed that patients were very satisfied with the care they were receiving. A questionnaire to staff 14 months after the change in the model of care showed that the biggest effect was felt to be increased continuity of care to patients, followed by more efficient clinic work flow and increased consistency of care. The responses to what they liked best about the new model of care as members of the health care team, showed that facilitating the planning and delivery of care to patients and having a primary physician assigned to each patient were the most liked, followed by having their patient care questions answered more consistently because they knew which physician to direct the question to and physicians were more aware of their dedicated patients. The patient satisfaction survey post change in model of care showed that patients were still highly satisfied with the care they received.

Conclusions: We showed that a model of care with a primary physician for each patient as well as assigned clinic days, alternating with some weeks where one physician covers the outpatient oncology patients for the whole week is a feasible model of care for a medium sized pediatric oncology program. The health care team found this model to be significantly better than a straight team based care model, but in a medium sized program with limited attending physicians, it provided a primary physician model that was felt to be beneficial for patients and other members of the health care team.