A novel cardio-oncology service line model in optimizing care access, quality and equity for large, multi-hospital health systems

Figures

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  Fig. 1. An academic cardio-oncology program that was established in partnership with a cancer center, with a focus on multidisciplinary collaboration, whole person care, and optimized patient outcomes. The program provides comprehensive cancer care, addressing all medical and supportive care needs, through a team of experts, including cardio-oncologists, vascular oncologists, specialists in advanced heart failure and infiltrative heart disease, a cardio-oncology pharmacist, a cardio-oncology administrative coordinator, and nurse practitioners. The cardio-oncology team works in close collaboration with the oncology team, with direct and efficient communication established through a cardio-oncology hotline and an encrypted designated email address. This enables real-time updates on the status and management of cardio-oncology patients. Overall, the program prioritizes the needs of the whole person, recognizing the complex interplay between cancer and cardiovascular health, and seeks to optimize patient outcomes through a collaborative, patient-centered approach

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  Fig. 2. The five key infrastructure elements of the cardio-oncology service line model: strategic vision and accountability, standardized system of care, dedicated staff and resources, patient experience and education, and branding and identity. These elements were developed and implemented across multiple hospitals and offices within our healthcare system to establish a system-wide cardio-oncology service line. The goal of this service line model is to create a quality-controlled, evidence-based, and centrally governed structure that provides optimal care for cardio-oncology patients

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  Fig. 3. The standardized system of care as the foundation of the service line model. A five essential protocols for care standardization are highlighted, demonstrating the emphasis on evidence-based care and the need for consistency in care across all healthcare facilities. These protocols are crucial to ensuring that all patients receive the same high-quality care, regardless of where they receive treatment within the healthcare system. B Cardio-oncology patient referral and clinical workflow is illustrated. This workflow was utilized in all branch offices to ensure timely scheduling of all referred patients. The workflow emphasizes a detail-oriented, step-by-step, close-end communication process to ensure that all records and recommendations are shared with the referring oncologists and providers once they become available. This ensures that all healthcare providers involved in the patient's care are informed and able to make informed decisions based on the patient's needs

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  Fig. 4. Cardio-oncology echocardiogram protocol. With 3D left ventricular ejection fraction and global longitudinal strain as the major highlights, the cardio-oncology echocardiogram protocol was created to standardize image acquisition, reporting and notification process. The cardio-oncology echocardiogram protocol was also equipped with an educational component. The protocol was implemented in all eleven echocardiogram labs with periodic and repeated training of echocardiogram technologists across health system

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  Fig. 5. The positive impact of implementing a service line care model on patient access to cardio-oncology services. Following the establishment of the service line model, the standardized cardio-oncology services were expanded from one medical center to eight different hospitals across the hospital system, including two rural hospitals. Outpatient cardio-oncology care was expanded from one outpatient care center to ten different locations, including three rural outreach offices. Consequently, the cardio-oncology service area significantly increased from 274 square miles to an estimated 4731 square miles, providing access to a population of 2.4 million. Furthermore, the service line model facilitated cardio-oncology care for an estimated rural population of 204,133 who previously lacked access to these services

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  Fig. 6. The significant impact of the service line care model on cardio-oncology clinic visits and strain echocardiography use. The implementation of the service line model resulted in an average 200% yearly increase in cardio-oncology patient visits, which eventually reached six times the initial volume within three years. Moreover, the appropriate utilization of strain echocardiography steadily improved year over year, leading to a remarkable over 20-fold increase in study utilization over the three-year period

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  Fig. 7. The substantial improvement in clinical flow quality measures following the establishment of the service line care model. These quality measures include the time from referral to office visit, time from referral to echocardiogram study, time from visit to consultation notes faxed to the referral provider, and time from study to reports faxed back to the referral provider. Notably, these measures have shown a significant year-over-year improvement when compared to the pre-standardization period

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  Fig. 8. Novel integrated academic cardio-oncology center model. In the setting of the highly specialized area and relatively limited patient population in cardio-oncology, the establishment of the service line care model has significantly improved patient access and expanded the patient population, providing a strong foundation for research and education in this field. This has subsequently facilitated the advancement of cardio-oncology as a whole, enabling academic cardio-oncology centers to further their efforts in research and education