Coordinating cancer care: patient and practice management processes among surgeons who treat breast cancer.
OBJECTIVE
The Institute of Medicine has called for more coordinated cancer care models that correspond to initiatives led by cancer providers and professional organizations. These initiatives parallel those underway to integrate the management of patients with chronic conditions.


METHODS
We developed 5 breast cancer patient and practice management process measures based on the Chronic Care Model. We then performed a survey to evaluate patterns and correlates of these measures among attending surgeons of a population-based sample of patients diagnosed with breast cancer between June 2005 and February 2007 in Los Angeles and Detroit (N = 312; response rate, 75.9%).


RESULTS
Surgeon practice specialization varied markedly with about half of the surgeons devoting 15% or less of their total practice to breast cancer, whereas 16.2% of surgeons devoted 50% or more. There was also large variation in the extent of the use of patient and practice management processes with most surgeons reporting low use. Patient and practice management process measures were positively associated with greater levels of surgeon specialization and the presence of a teaching program. Cancer program status was weakly associated with patient and practice management processes.


CONCLUSIONS
Low uptake of patient and practice management processes among surgeons who treat breast cancer patients may indicate that surgeons are not convinced that these processes matter, or that there are logistical and cost barriers to implementation. More research is needed to understand how large variations in patient and practice management processes might affect the quality of care for patients with breast cancer.
Katz
Steven J
SJ
Department of Internal Medicine and Health Management Policy, University of Michigan Health System, Ann Arbor, MI 48109, USA. skatz@umich.edu
Hawley
Sarah T
ST
Morrow
Monica
M
Griggs
Jennifer J
JJ
Jagsi
Reshma
R
Hamilton
Ann S
AS
Graff
John J
JJ
Friese
Christopher R
CR
Hofer
Timothy P
TP
D001943:Breast Neoplasms / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D007256:Information Systems; D007400:Interprofessional Relations; D008297:Male; D008511:Medicine / Q000458:organization & administration*; D010358:Patient Participation; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000458:organization & administration*