The patient-breast cancer care pathway: how could it be optimized?

BMC Cancer

Study Protocol

Bernard Asselain¹  Aline Combes²  Caroline Trichot³  Karine Alves⁴  Martin Koskas⁵  Thuy Nguyen⁶  Cyrille Huchon⁷  Hélène Berseneff⁸  Sandrine Baffert⁹  Huong Ly Hoang⁹  Anne Brédart^1,10  Séverine Alran^1,11  Aurélie Roulot^1,12  Delphine Héquet^1,13  Roman Rouzier^1,13 

[1] Department of Biostatistics, Institut Curie, 26 rue d’Ulm, 75005, Paris, France;Department of Gynecology, André Mignot Hospital, 78000, 50 rue Berthier, Versailles, France;Department of Gynecology, Antoine Béclère Hospital, 157 rue de la Porte de Trivaux, 92140, Clamart, France;Department of Gynecology, Argenteuil Hospital, 69 Rue Lt Colonel Prudhon, 95100, Argenteuil, France;Department of Gynecology, Bichat Hospital, 46 rue Henri Huchard, 75018, Paris, France;Department of Gynecology, Louis Mourier Hospital, 178 rue des Renouillers, 92700, Colombes, France;Department of Gynecology, Poissy-St Germain hospital, 10 Rue du Champ Gaillard, 78300, Poissy, France;Department of Gynecology, René Dubos Hospital, 6, avenue de L’Ile de France, 95303, Pontoise, France;Department of Health Economy, Institut Curie, 26 rue d’Ulm, 75005, Paris, France;Department of Supportive Care, Institut Curie, 26 rue d’Ulm, 75005, Paris, France;Department of Surgical Oncology, Institut Curie, 26 rue d’Ulm, 75005, Paris, France;Department of Surgical Oncology, Institut Curie-René Huguenin, 35 rue Dailly, 92210, St Cloud, France;Department of Surgical Oncology, Institut Curie-René Huguenin, 35 rue Dailly, 92210, St Cloud, France;Equipe d’Accueil 7285, Risk and safety in clinical medicine for women and perinatal health, University Versailles-Saint-Quentin, Montigny-le-Bretonneux, France;

关键词: Care pathway;    Breast cancer;    Cost analysis;    Bundled payment;   

DOI  :  10.1186/s12885-015-1417-4

 received in 2015-03-22, accepted in 2015-05-05,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundA care pathway is defined as patient-focused global care that addresses temporal (effective and coordinated management throughout the illness) and spatial issues (treatment is provided near the health territory in or around the patient’s home). Heterogeneity of the care pathways in breast cancer (BC) is presumed but not well evaluated. The OPTISOINS01 study aims to assess every aspect of the care pathway for early BC patients using a temporal and spatial scope.Methods/DesignAn observational, prospective, multicenter study in a regional health territory (Ile-de-France, France) in different types of structures: university or local hospitals and comprehensive cancer centers. We will include and follow during 1 year 1,000 patients. The study consists of 3 work-packages:- Cost of pathwayThe aim of this WP is to calculate the overall costs of the early BC pathway at 1 year from different perspectives (society, health insurance and patient) using a cost-of-illness analysis. Using a bottom-up method, we will assess direct costs, including medical direct costs and nonmedical direct costs (transportation, home modifications, home care services, and social services), and indirect costs (loss of production).- Patient satisfaction and work reintegrationThree questionnaires will assess the patients’ satisfaction and possible return to work: the occupational questionnaire for employed women; the questionnaire on the need for supportive care, SCNS-SF34 (‘breast cancer’ module, SCNS-BR8); and the OUTPASSAT-35 questionnaire.- Quality, coordination and access to innovationQuality will be evaluated based on visits and treatment within a set period, whether the setting offers a multidisciplinary consultative framework, the management by nurse coordinators, the use of a personalized care plan, the provision of information via documents about treatments and the provision of supportive care.The coordination between structures and caregivers will be evaluated at several levels. Day surgery, home hospitalization and one-stop breast clinic visits will be recorded to assess the patient’s access to innovation.DiscussionThe assessment of care pathways encourages the implementation of new payment models. Our approach could help health care professionals and policymakers to establish other cost-of-illness studies and plan the allocation of resources on a patient basis rather than a visit basis.

【 授权许可】

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© Baffert et al.; licensee BioMed Central. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.