Implementation of a Multidisciplinary Expert Testicular Cancer Tumor Board Across a Large Integrated Healthcare Delivery System Via Early Case Ascertainment

Author:

Harzstark Andrea L.1,Altschuler Andrea2,Amsden Laura B.2,Alavi Mubarika2,Liu Liyan2,Presti Joseph C.12,Brenman Leslie Manace3,Walker Lauren C.1,Ryken Rene R.3,De Mucha Flores Aileen C.3,Nichols Craig4,Herrinton Lisa J.2

Affiliation:

1. Department of Urology, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA

2. Division of Research, Kaiser Permanente Northern California, Oakland, CA

3. Department of Precision Tracking, Regional Offices, Kaiser Permanente Northern California, Oakland, CA

4. Department of Hematology and Oncology, Oregon Health and Science University, Portland, OR

Abstract

PURPOSE In 2016, Kaiser Permanente Northern California began regionalizing testicular cancer care using population-based tumor board review. This mixed methods evaluation describes implementation outcomes and learnings. METHODS We conducted in-depth interviews with key stakeholders, administered surveys to local oncologists and urologists, and used clinical data to evaluate changes in care delivery during 2015-2018. RESULTS An average of 135 patients with testicular cancer were diagnosed each year. Interviews with 16 key stakeholders provided several insights. Implementation resulted in high levels of satisfaction, was dependent on leadership and staff at various levels, and required technology and consulting solutions aligned to user agreements and clinical workflows. Of 123 local oncologists and urologists who completed surveys, 97% understood why care was regionalized and 89% agreed that tumor board review improved treatment decisions. Among 177 patients with stage I seminoma, the percentage appropriately observed rather than treated with adjuvant chemotherapy or radiation therapy increased from 48% (95% CI, 35 to 62) in 2015 to 87% (75 to 99) in 2018. Review altered care based on pathology and radiology re-review in 14.5 % of cases. CONCLUSION Regionalization was feasible and effective.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

General Medicine

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