A Distributed Cancer Care Model with a Technology-Driven Hub-and-Spoke and further Spoke Hierarchy: Findings from a Pilot Implementation Programme in Kerala, India

Abstract

Background:The technology enabled distributed model in Kerala is based on an innovative partnership model between Karkinos Healthcare and private health centers. The model is designed to address the barriers to cancer screening by generating demand and by bringing together the private health centers and service providers at various levels to create a network for continued care. This paper describes the implementation process and presents some preliminary findings. Methods: The model follows the hub-and-spoke and further spoke framework. In the pilot phases, from July 2021 to December 2021, five private health centers (partners) collaborated with Karkinos Healthcare across two districts in Kerala. Screening camps were organized across the districts at the community level where the target groups were administered a risk assessment questionnaire followed by screening tests at the spoke hospitals based on a defined clinical protocol. The screened positive patients were examined further for confirmatory diagnosis at the spoke centers. Patients requiring chemotherapy or minor surgeries were treated at the spokes. For radiation therapy and complex surgeries the patients were referred to the hubs. Results: A total of 2,459 individuals were screened for cancer at the spokes and 299 were screened positive. Capacity was built at the spokes for cancer surgery and chemotherapy. A total of 189 chemotherapy sessions and 17 surgeries were performed at the spokes for cancer patients. 70 patients were referred to the hub. Conclusion: Initial results demonstrate the ability of the technology Distributed Cancer Care Network (DCCN) system to successfully screen and detect cancer and to converge the actions of various private health facilities towards providing a continuum of cancer care. The lessons learnt from this study will be useful for replicating the process in other States.

Role of digital health in coordinating patient care in a hub-and-spoke hierarchy of cancer care facilities: a scoping review

“…Another study in the US conducted by Harris et al [ 37 ] investigated whether a technology-enabled hub-and-spoke model could support peer review in radiation oncology and lead to standardisation of cancer care across facilities. The study based in India described the implementation of a hub-and-spoke model for cancer care and the use of digital applications for risk assessment and navigating patients across facilities [ 23 ].…”

“…Two studies followed a mixed methods approach [ 24 , 25 ], four were observational studies [ 23 , 27 , 28 ] and one was a prospective study [ 26 ]. Overall, the studies highlighted that technology can be used for capacity building, providing specialised care in remote areas, and to navigate patients to facilities for diagnosis and treatment.…”

“…Ramachandran et al [ 23 ] described the working of a distributed cancer care model which was conceptualised with an aim to generate the demand for cancer screening and to overcome the barriers related to access to healthcare facilities in Kerala, India. The key characteristic of this model was the use of technology to serve patients residing in rural areas and to guide junior oncologists at spoke centres.…”

“…Of the seven studies, one was conducted in 2013 [24] and two in 2017 [25,37] while the rest four were conducted during 2021-22 [23,[26][27][28].…”

“…Two studies followed a mixed methods approach [24,25], four were observational studies [23,27,28] and one was a prospective study [26].…”