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Foreword

Foreword Scientific discovery transformed health care and resulted in major improvements in population health during the 20th century. As we enter the 21st century, the potential for continued application of scientific discovery, particularly in the area of genetics and molecular therapies, is anticipated to further transform health care. However, despite these major scientific discoveries, much less is known about characteristics of health-care delivery processes and systems that will maximize the potential for ensuring rapid translation of future scientific discovery and high quality of care to all. Over the first decade of the 21st century, rapid increases in the number of people who are uninsured and even greater increases in the underinsured accelerated the urgency of the debate about health care in the United States. It is clear that many policy makers, physicians, and people using health care are dissatisfied with how we deliver care in the United States. This supplement addresses an area of critical need; how best to organize care so that people and their care do not suffer as they transition their care between primary and oncology-specialty providers. The potential for patients to be lost and quality of care to be adversely affected during these transitions in providers has been identified as one of the major gaps resulting from the lack of an organized health-care system. Contributing authors from the United States and Canada recognize this common problem. Improvements in care must address both access for those who do not have it and the process of care for everyone. A number of reports in the last decade, including the classic Institute of Medicine reports on the quality chasm, have identified key elements and deconstructed processes of care that must be addressed to ensure quality of care. This supplement moves beyond that important initial work in distinguishing between the steps in care that are the usual focus of guidelines to focusing on the connections between these steps that have seldom been examined in research or addressed in practice. Those connections, termed interfaces of care in this supplement, involve communication within and across a number of groups, including patients and their families, primary care and oncological specialty care physicians, and other affiliated health-care professionals who make up the team of providers. This supplement raises issues about these interfaces that are directly relevant to identifying how anticipated health-care delivery changes could be restructured to consciously address some very specific gaps in the process of care. This supplement digs deeper into this aspect of the cancer care process and highlights future research opportunities. These authors suggest that first and foremost among these issues at the interface of primary and oncology-related specialty care are the transfer of information and responsibility. As Taplin (1) points out in the introduction, this problem is complex because of the many people and organizations involved—particularly as these people are not supported by an organized approach to ensuring functioning networks of communication. This issue may be especially complex for oncology care because it is much more common that many more people are involved. The multimodality therapies that form the foundation of oncology care require the engagement of multiple primary and subspecialty physicians, other health-care professionals, family and even community organizations, given the use of hospice care for managing end of life. This reality further increases the potential for failure across these interfaces; Fennell et al. (2) examine the potential for one organization structure, the multidisciplinary team care model, to reduce those failures. As with many complex medical conditions, providers are challenged with providing the right care to the right person at the right time in their clinical course. Hesse et al. (3) raise the possibility that information technology may be a valuable tool in facilitating this process, but he also suggests that information technology will only help if we design it with the users in mind. A research agenda that will clarify how to transfer responsibility clearly, how to make sure patients know what they need and want to know, how both affect care, and whether information technology is a useful tool is important to making positive progress as the millennium unfolds. But the supplement points out that the interfaces of care are affected by the multilevel context in which care is delivered. Research into the context of care has expanded; however, Anhang Price et al. (4) argue persuasively that more must be done to examine and change the context of care to address the interfaces. But they also point out that research addressing problems at the interfaces of care in screening and follow-up is limited. Deeper examination of alternative models of multilevel interventions and quantification of their effects are needed as we move forward to change the structure and practice of health-care delivery. Finally, as is increasingly recognized across all areas of research and articulated by Murray et al. (5), attention must be given to developing and applying appropriate methods and research designs that can be used to deconstruct which components of multilayered and multifaceted health-care delivery result in the greatest improvements in care. The issues detailed and debated in this supplement are central to informing national debates about ensuring high quality of care to all. It examines the process of care from a new vantage point and comprehensively reports the strengths and weakness of what is known about the interfaces of care. The need to incorporate patients, families, and communities in the dialogue is a central theme of the supplement. The Institute of Medicine report on the quality chasm advocated for putting patients back in the center of care. For the first time, these articles incorporate patients as participants with explicit voices and insights on how to improve their own care. References 1. Taplin SH , Rodgers AB . Toward improving the quality of cancer care: addressing the interfaces of primary and oncology-related subspecialty care , J Natl Cancer Inst Monogr , 2010 , vol. 40 (pg. 3 - 10 ) Google Scholar Crossref Search ADS WorldCat 2. Fennell ML , Prabhu Das I , Clauser S , Petrelli N , Salner A . The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality , J Natl Cancer Inst Monogr , 2010 , vol. 40 (pg. 72 - 80 ) Google Scholar Crossref Search ADS WorldCat 3. Hesse BW , Hanna C , Massett HA , Hesse NK . Outside the box: will information technology be a viable intervention to improve the quality of cancer care? , J Natl Cancer Inst Monogr , 2010 , vol. 40 (pg. 81 - 89 ) Google Scholar Crossref Search ADS WorldCat 4. Anhang Price R , Zapka J , Edwards H , Taplin SH . Organizational factors and the cancer screening process , J Natl Cancer Inst Monogr , 2010 , vol. 40 (pg. 52 - 71 ) OpenURL Placeholder Text WorldCat 5. Murray D , Pennell M , Rhoda D , Hade E , Paskett E . Designing studies that would address the multilayered nature of health care , J Natl Cancer Inst Monogr , 2010 , vol. 40 (pg. 90 - 96 ) Google Scholar Crossref Search ADS WorldCat Published by Oxford University Press 2010. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JNCI Monographs Oxford University Press

Foreword

Ballard-Barbash,, Rachel
JNCI Monographs , Volume 2010 (40) – Apr 1, 2010
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References (5)

Publisher
Oxford University Press
Copyright
Published by Oxford University Press 2010.
ISSN
1052-6773
eISSN
1745-6614
DOI
10.1093/jncimonographs/lgq005
Publisher site
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Abstract

Scientific discovery transformed health care and resulted in major improvements in population health during the 20th century. As we enter the 21st century, the potential for continued application of scientific discovery, particularly in the area of genetics and molecular therapies, is anticipated to further transform health care. However, despite these major scientific discoveries, much less is known about characteristics of health-care delivery processes and systems that will maximize the potential for ensuring rapid translation of future scientific discovery and high quality of care to all. Over the first decade of the 21st century, rapid increases in the number of people who are uninsured and even greater increases in the underinsured accelerated the urgency of the debate about health care in the United States. It is clear that many policy makers, physicians, and people using health care are dissatisfied with how we deliver care in the United States. This supplement addresses an area of critical need; how best to organize care so that people and their care do not suffer as they transition their care between primary and oncology-specialty providers. The potential for patients to be lost and quality of care to be adversely affected during these transitions in providers has been identified as one of the major gaps resulting from the lack of an organized health-care system. Contributing authors from the United States and Canada recognize this common problem. Improvements in care must address both access for those who do not have it and the process of care for everyone. A number of reports in the last decade, including the classic Institute of Medicine reports on the quality chasm, have identified key elements and deconstructed processes of care that must be addressed to ensure quality of care. This supplement moves beyond that important initial work in distinguishing between the steps in care that are the usual focus of guidelines to focusing on the connections between these steps that have seldom been examined in research or addressed in practice. Those connections, termed interfaces of care in this supplement, involve communication within and across a number of groups, including patients and their families, primary care and oncological specialty care physicians, and other affiliated health-care professionals who make up the team of providers. This supplement raises issues about these interfaces that are directly relevant to identifying how anticipated health-care delivery changes could be restructured to consciously address some very specific gaps in the process of care. This supplement digs deeper into this aspect of the cancer care process and highlights future research opportunities. These authors suggest that first and foremost among these issues at the interface of primary and oncology-related specialty care are the transfer of information and responsibility. As Taplin (1) points out in the introduction, this problem is complex because of the many people and organizations involved—particularly as these people are not supported by an organized approach to ensuring functioning networks of communication. This issue may be especially complex for oncology care because it is much more common that many more people are involved. The multimodality therapies that form the foundation of oncology care require the engagement of multiple primary and subspecialty physicians, other health-care professionals, family and even community organizations, given the use of hospice care for managing end of life. This reality further increases the potential for failure across these interfaces; Fennell et al. (2) examine the potential for one organization structure, the multidisciplinary team care model, to reduce those failures. As with many complex medical conditions, providers are challenged with providing the right care to the right person at the right time in their clinical course. Hesse et al. (3) raise the possibility that information technology may be a valuable tool in facilitating this process, but he also suggests that information technology will only help if we design it with the users in mind. A research agenda that will clarify how to transfer responsibility clearly, how to make sure patients know what they need and want to know, how both affect care, and whether information technology is a useful tool is important to making positive progress as the millennium unfolds. But the supplement points out that the interfaces of care are affected by the multilevel context in which care is delivered. Research into the context of care has expanded; however, Anhang Price et al. (4) argue persuasively that more must be done to examine and change the context of care to address the interfaces. But they also point out that research addressing problems at the interfaces of care in screening and follow-up is limited. Deeper examination of alternative models of multilevel interventions and quantification of their effects are needed as we move forward to change the structure and practice of health-care delivery. Finally, as is increasingly recognized across all areas of research and articulated by Murray et al. (5), attention must be given to developing and applying appropriate methods and research designs that can be used to deconstruct which components of multilayered and multifaceted health-care delivery result in the greatest improvements in care. The issues detailed and debated in this supplement are central to informing national debates about ensuring high quality of care to all. It examines the process of care from a new vantage point and comprehensively reports the strengths and weakness of what is known about the interfaces of care. The need to incorporate patients, families, and communities in the dialogue is a central theme of the supplement. The Institute of Medicine report on the quality chasm advocated for putting patients back in the center of care. For the first time, these articles incorporate patients as participants with explicit voices and insights on how to improve their own care. References 1. Taplin SH , Rodgers AB . Toward improving the quality of cancer care: addressing the interfaces of primary and oncology-related subspecialty care , J Natl Cancer Inst Monogr , 2010 , vol. 40 (pg. 3 - 10 ) Google Scholar Crossref Search ADS WorldCat 2. Fennell ML , Prabhu Das I , Clauser S , Petrelli N , Salner A . The organization of multidisciplinary care teams: modeling internal and external influences on cancer care quality , J Natl Cancer Inst Monogr , 2010 , vol. 40 (pg. 72 - 80 ) Google Scholar Crossref Search ADS WorldCat 3. Hesse BW , Hanna C , Massett HA , Hesse NK . Outside the box: will information technology be a viable intervention to improve the quality of cancer care? , J Natl Cancer Inst Monogr , 2010 , vol. 40 (pg. 81 - 89 ) Google Scholar Crossref Search ADS WorldCat 4. Anhang Price R , Zapka J , Edwards H , Taplin SH . Organizational factors and the cancer screening process , J Natl Cancer Inst Monogr , 2010 , vol. 40 (pg. 52 - 71 ) OpenURL Placeholder Text WorldCat 5. Murray D , Pennell M , Rhoda D , Hade E , Paskett E . Designing studies that would address the multilayered nature of health care , J Natl Cancer Inst Monogr , 2010 , vol. 40 (pg. 90 - 96 ) Google Scholar Crossref Search ADS WorldCat Published by Oxford University Press 2010.

Journal

JNCI Monographs – Oxford University Press

Published: Apr 1, 2010

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