title: Promoting the Shared-Care Model for Adolescent and Young Adults With Cancer: Optimizing Referrals and Care Coordination With Primary Care Providers.
abstract: The "shared-care model" for patients with cancer involves care coordination between primary care providers (PCPs) and oncologists, with the goal of optimizing survivorship care. However, a high proportion of adolescent and young adult (AYA) cancer survivors do not have a PCP. Study objectives were to increase the percentage of AYAs with a PCP documented in the electronic medical record (EMR) via the use of a best practice advisory (BPA) or "stopgap" intervention; to increase communication between providers by the number of routed clinic notes; and to assess oncology providers' attitudes/beliefs about the model and intervention.
  
  
  
  Data were collected for the 6 months before implementation of the BPA to determine the percentage of AYAs with a PCP and the number of notes routed to providers (time point 1 [T1]). The same data were collected at time point 2 (T2) after the BPA had been implemented for 6 months. Oncology providers participated in an education video module and an online survey at T1 and a survey at T2.
  
  
  
  At T1, 47.1% of 756 AYAs had a documented PCP in the EMR. At T2, the percentage increased to 55.1% (P<.002). The number of routed notes did not change significantly from T1 to T2. Providers that completed the intervention survey agreed/strongly agreed that the shared-care model is a desirable model of care (T1 = 86%; T2 = 93%) and that a BPA is useful for facilitating PCP referrals (T1 = 76%; T2 = 39%).
  
  
  
  This BPA is feasible for increasing the percentage of AYAs with a PCP documented in the EMR and could potentially lead to increased PCP referral and communication among providers for the benefit of long-term survivorship care. Providers generally agree with the shared-care model; however, the BPA implementation requires modification.
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois
authors.forename: Karen E
authors.initials: KE
authors.lastname: Kinahan
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois|Northwestern University Feinberg School of Medicine, Chicago, Illinois
authors.forename: Sheetal
authors.initials: S
authors.lastname: Kircher
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois|Northwestern University Feinberg School of Medicine, Chicago, Illinois
authors.forename: Jessica
authors.initials: J
authors.lastname: Altman
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois|Northwestern University Feinberg School of Medicine, Chicago, Illinois|Department of Preventive Medicine-Biostatistics, Northwestern University, Chicago, Illinois
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.affiliation: Department of Social Sciences and Health Policy, Wake Forest School of Medicine & Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina
authors.forename: John M
authors.initials: JM
authors.lastname: Salsman
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois|Northwestern University Feinberg School of Medicine, Chicago, Illinois
authors.forename: Aarati
authors.initials: A
authors.lastname: Didwania
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois|Rush University College of Nursing, Chicago, Illinois
authors.forename: Bridget
authors.initials: B
authors.lastname: O'Brien
authors.affiliation: Northwestern Medicine, Chicago, Illinois
authors.forename: Alpa C
authors.initials: AC
authors.lastname: Patel
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois|Northwestern University Feinberg School of Medicine, Chicago, Illinois|Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
authors.forename: Stacy D
authors.initials: SD
authors.lastname: Sanford
mesh_terms: D000293:Adolescent; D000328:Adult; D057286:Electronic Health Records; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D033183:Interdisciplinary Communication; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D000072103:Oncologists / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D015996:Survival Rate; D017741:Survivors; D055815:Young Adult