Co-located multidisciplinary clinics — where newly diagnosed cancer patients meet with all of their cancer specialists on the same day — can expedite time to treatment, reduce costs and improve outcomes, according to a study published Feb. 20 in the Journal of Oncology Practice.
Fairfax, Va.-based Inova Health researchers found that patients who attended a multidisciplinary clinic began treatment about 9.5 days sooner than patients who received standard care. The clinics were also associated with improved guideline adherence, reduced diagnostic expenditures and improved overall survival.
John Deeken, MD, president of Inova Schar Cancer, shared more about the study’s findings with Becker’s, and what they could mean for the future of cancer care.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: Among the outcomes you measured, which do you view as the most clinically or operationally meaningful?
Dr. John Deeken: The most meaningful by far is survival. If this method of getting newly diagnosed cancer patients in to see their expert team and get treatment coordinated and started as fast as possible leads to more patients surviving their cancer, then there clearly is no reason not to do this.
Q: Same-day multidisciplinary clinics require significant coordination, what does the operational model look like on a typical clinic day?
JD: At Inova Schar, our multidisciplinary clinic approach does take a good deal of coordination.
- We have new patient coordinators helping to schedule patients, get all available records and coordinate the schedule.
- We have new patient nurse navigators who talk to the patient at length before their clinic day, coordinate any tests or radiology studies that need to be done and answer all questions.
- Our clinics usually start in the morning before, when the treating physicians and team review the new cases, typically with the radiologists and sometimes the pathologists to make sure we have all of the data we can.
- The new patient and their family are brought into an exam room and each physician takes turns coming in to meet the patient, hear their story, do a physical exam and discuss treatment options.
- After all of the physicians have seen each patient, they compare notes and come up with a unified plan.
- In between the physician meetings the patients meet other members of the care team, including social workers, therapists, clinic nurses, pharmacists and research staff.
- We typically see three to seven new patients in a half-day clinic using this approach.
Q: What are the biggest logistical challenges in co-locating specialists and aligning schedules in real time?
JD: Once physicians and the teams have their schedules set up and blocked for the clinic, there usually is not a problem. We schedule far enough in advance so that if one physician is out, another can be scheduled in. Initially physicians may think it is not as efficient in the use of their time compared to a regular clinic where they are seeing follow up patients as well as new patients, but our physicians find that multidisciplinary clinics are actually more efficient since they do not need to call and coordinate care with the other physicians when they are not seen together. Changing the mindset of physicians was our biggest challenge, but since everyone got on board, no one has asked to go back to the old way of doing things.
Q: How should health system leaders think about the upfront investment required to stand up this model versus the downstream savings?
JD: There is a higher staffing cost to set up this process, including for the new patient coordinators and nurse navigators, but patients love it and feel that their care is coordinated and moving ahead quickly. Health system leaders should look at the higher patient volumes, higher patient retention and higher patient satisfaction as some of the KPIs for investing in multidisciplinary clinics, in addition to the key findings our study found in terms of patients’ outcomes.
Q: Given these findings, do you believe same-day multidisciplinary care should become a standard of care?
JD: We 100% believe this should be the standard of care for all new cancer patients. With the increasing use of telemedicine, we believe that all patients can be offered this better way of providing and coordinating care even in rural areas where providers may be far from each other. As we found, multidisciplinary clinics can actually save money especially for patients, so this should be attractive to those physicians caring for patients in resource-constrained settings.
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