Patient-centered care coordination in hematopoietic cell transplantation

Abstract

Hematopoietic cell transplantation (HCT) is an expensive, resource-intensive, and medically complicated modality for treatment of many hematologic disorders. A well-defined care coordination model through the continuum can help improve health care delivery for this high-cost, high-risk medical technology. In addition to the patients and their families, key stakeholders include not only the transplantation physicians and care teams (including subspecialists), but also hematologists/oncologists in private and academic-affiliated practices. Initial diagnosis and care, education regarding treatment options including HCT, timely referral to the transplantation center, and management of relapse and late medical or psychosocial complications after HCT are areas where the referring hematologists/ oncologists play a significant role. Payers and advocacy and community organizations are additional stakeholders in this complex care continuum. In this article, we describe a care coordination framework for patients treated with HCT within the context of coordination issues in care delivery and stakeholders involved. We outline the challenges in implementing such a model and describe a simplified approach at the level of the individual practice or center. This article also highlights ongoing efforts from physicians, medical directors, payer representatives, and patient advocates to help raise awareness of and develop access to adequate tools and resources for the oncology community to deliver well-coordinated care to patients treated with HCT. Lastly, we set the stage for policy changes around appropriate reimbursement to cover all aspects of care coordination and generate successful buy-in from all stakeholders.

Transplant center characteristics and survival after allogeneic hematopoietic cell transplantation in adults

“…Several barriers to care after patients are discharged from the transplant center (typically around day 100 after HCT) have been described, and coordinated survivorship care may enhance long-term patient outcomes beyond 1 year after transplantation. 11,41,42 We acknowledge that presence of survivorship clinic may be a surrogate for other center resources and characteristics that were not captured on our survey. We also recognize the variability in the organization of survivorship clinics that currently exist at transplant centers and optimizing care models for HCT survivors is an area of active research.…”

Unique Challenges of Hematopoietic Cell Transplantation in Adolescent and Young Adults with Hematologic Malignancies

“…Thus, care coordination across the various transplantation phases from pretransplantation to post-transplantation survivorship phase, and as AYAs transition from one site of care to another, is critical. Khera et al [97] have provided a template for issues to consider along with strategies to optimize care coordination in HCT recipients that can be readily applied to the AYA population ( Supplementary Tables 1-4).…”

Driving Distance and Patient-Reported Outcomes in Hematopoietic Cell Transplantation Survivors

“…Our unexpectedly negative results with regard to driving distance and PROs are possibly a reflection of 2 underlying factors: (1) adequate telehealth follow-up or (2) differential loss to follow-up. With regard to the first factor, telehealth follow-up—which can range from phone calls to video visits to biometric data monitoring—is considered a core component of LTFU care for HCT survivors [35] . More integrative telehealth strategies include digital coaching programs, which have been shown to improve QOL and pain among HCT survivors [ 68 , 69 ].…”

“…HCT survivors who reside further from their transplantation centers have fewer post-HCT appointments than those who live closer [32,33]. This finding is likely attributable to logistical difficulties associated with attending such appointments, for example, transportation costs as well as the need for patients/caregivers to miss work in order to travel to/ from appointments [34,35]. Although telehealth-based evaluations of HCT recipients are feasible and recommended as a component of LTFU care [35,36], long-distance survivors may nevertheless be disadvantaged with regard to in-person resources for physical and emotional health such as specialized physical therapy evaluations, thorough evaluations for cGVHD-related fasciitis, or wellness-related group classes with a psychoeducational focus.…”