title: Coordinating cancer care: patient and practice management processes among surgeons who treat breast cancer.
abstract: 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.
authors: Department of Internal Medicine and Health Management Policy, University of Michigan Health System, Ann Arbor, MI 48109, USA. skatz@umich.edu
authors: Steven J
authors: SJ
authors: Katz
authors: Sarah T
authors: ST
authors: Hawley
authors: Monica
authors: M
authors: Morrow
authors: Jennifer J
authors: JJ
authors: Griggs
authors: Reshma
authors: R
authors: Jagsi
authors: Ann S
authors: AS
authors: Hamilton
authors: John J
authors: JJ
authors: Graff
authors: Christopher R
authors: CR
authors: Friese
authors: Timothy P
authors: TP
authors: Hofer
mesh_terms: 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*