CARE CYCLE ON ADVANCED CANCER: REFORMING A VALUE-BASED SYSTEM

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Abstract

Background

In Japan, reconstruction of medical service system for cancer patients is urgent necessity. We conducted to extrapolate from the concept of care cycles to management for cancer patients. Consequently we constructed the care delivery value chain (CDVC) for cancer care.

Methods

In our facility, the cancer care team conducted by medical oncologists provides the best value across the full span of care services. In order to manage our CDVC for advanced cancer, we innovated ‘Annshin Card’ system. ‘Annshin’ means comfort in Japan. This card functions as a key among the patients, home nursing teams and us. We analyzed 454 patients from the tumor registry of our hospital from 12 July 2010 to 23 January 2012. The following factors were evaluated: (i) the overall incidence rate of an emergency visit among patients with an ‘Annshin Card’, (ii) length of hospitalization and rate of mortality at palliative care units (PCU) and (iii) cost–benefit.

Results

(i) Of 454 patients, 248 patients was adopted ‘Annshin Card’ system. Among patients with an ‘Annshin Card’, the overall incidence rate of an emergency visit was 2.7 visits per 100 patients per month (2.7/100/month). (ii) Of 454 patients, 205 patients have been hospitalized in PCU and 375 events of hospitalization to PCU occurred. On 375 events, the average of length of hospitalization was 19.3 [0–157] days; leaving hospital mortality was 131 events (34.9%). (iii) In cost benefit on our facility, before versus after launching our system, \393 714 ($5113) versus \526 862 ($6842)/patient/month, respectively. Conclusions: Our CDVC for cancer care produced not only clinical benefits but cost–benefit on our facility. We suppose that the concept of care cycles is definitely important for cancer patient management.

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