Clinical Multiteam System Composition and Complexity Among Newly Diagnosed Early-Stage Breast, Colorectal, and Lung Cancer Patients With Multiple Chronic Conditions: A SEER-Medicare Analysis

Abstract

PURPOSE: Sixty percent of adults have multiple chronic conditions at cancer diagnosis. These patients may require a multidisciplinary clinical team-of-teams, or a multiteam system (MTS), of high-complexity involving multiple specialists and primary care, who, ideally, coordinate clinical responsibilities, share information, and align clinical decisions to ensure comprehensive care needs are managed. However, insights examining MTS composition and complexity among individuals with cancer and comorbidities at diagnosis using US population-level data are limited. METHODS: Using SEER-Medicare data (2006-2016), we identified newly diagnosed patients with breast, colorectal, or lung cancer who had a codiagnosis of cardiopulmonary disease and/or diabetes (n = 75,201). Zaccaro's theory-based classification of MTSs was used to categorize clinical MTS complexity in the 4 months following cancer diagnosis: high-complexity (≥ 4 clinicians from ≥ 2 specialties) and low-complexity (1-3 clinicians from 1-2 specialties). We describe the proportions of patients with different MTS compositions and quantify the incidence of high-complexity MTS care by patient groups. RESULTS: The most common MTS composition was oncology with primary care (37%). Half (50.3%) received high-complexity MTS care. The incidence of high-complexity MTS care for non-Hispanic Black and Hispanic patients with cancer was 6.7% (95% CI, −8.0 to −5.3) and 4.7% (95% CI, −6.3 to −3.0) lower than non-Hispanic White patients with cancer; 13.1% (95% CI, −14.1 to −12.2) lower for rural residents compared with urban; 10.4% (95% CI, −11.2 to −9.5) lower for dual Medicaid-Medicare beneficiaries compared with Medicare-only; and 16.6% (95% CI, −17.5 to −15.8) lower for colorectal compared with breast cancer. CONCLUSION: Incidence differences of high-complexity MTS care were observed among cancer patients with multiple chronic conditions from underserved populations. The results highlight the need to further understand the effects of and mechanisms through which care team composition, complexity, and functioning affect care quality and outcomes.

Improving the quality of patient care in lung cancer: key factors for successful multidisciplinary team working

“…The cancer healthcare system can be envisioned as a multilevel set of factors that affect patients at the different stages of the cancer treatment continuum and various forms of teamwork are executed by different overlapping care providers in this continuum [ 82 ]. Furthermore, the prevalence of multiple chronic conditions among lung cancer patients may require a multidisciplinary clinical “team of teams” or a multi-team system [ 83 ]. The multi-team system is defined as an “interdependent, highly specialized, and geographically dispersed team of teams involved in the care and health of a particular person” [ 84 ] which, ideally, coordinates responsibilities, shares information, and aligns clinical decisions to ensure that comprehensive patient needs are managed [ 83 ] across geographic, organizational, and disciplinary boundaries.…”

“…Furthermore, the prevalence of multiple chronic conditions among lung cancer patients may require a multidisciplinary clinical “team of teams” or a multi-team system [ 83 ]. The multi-team system is defined as an “interdependent, highly specialized, and geographically dispersed team of teams involved in the care and health of a particular person” [ 84 ] which, ideally, coordinates responsibilities, shares information, and aligns clinical decisions to ensure that comprehensive patient needs are managed [ 83 ] across geographic, organizational, and disciplinary boundaries. In cancer care, this “team of teams”, is responsible for coordinating patient healthcare, and often includes physicians, nurses, advanced practice registered nurses, physician assistants, palliative care specialists, clinicians providing psychosocial support, spiritual workers, rehabilitation specialists, pharmacists, hospice clinicians, and others [ 84 ].…”

“…MDTs should consider how they could engage with other teams to support individuals with multiple care and social needs. The cancer healthcare system can be envisioned as a multilevel set of factors that affect patients at the different stages of the cancer treatment continuum and various forms of teamwork are executed by different overlapping care providers in this continuum [82]. Furthermore, the prevalence of multiple chronic conditions among lung cancer patients may require a multidisciplinary clinical "team of teams" or a multi-team system [83].…”

Teams, Teaming, and Complex Systems in Cancer Care

“…13 The idea is that by capitalizing on the insights from different specialties, all sides of a case can be considered, and the collective diagnosis and course of treatment can be optimized (Doose). 14 Yet we know from the science of team science that such specialists experience representational gaps as they conceptualize issues in different fashions, have different priorities, and speak different languages (ie, interests and understandings 15 ). This requires mechanisms to both incorporate different perspectives and integrate their implications.…”

Social science and teams: a patient perspective

“…professional team, care team, surgical team, multidisciplinary team) [1]. In essence, this represents what is referred to as a multiteam system [4], or sets of interdependent teams where members work toward a common goal within their team (e.g. care for patient X) as well as working across teams to accomplish a superordinate goal (e.g.…”