The objective of this study was to explore the implementation of a payment and delivery system innovation to improve coordination and communication between primary care and oncology. We employed a qualitative case study approach, conducting interviews (n = 18), and reviewing archival materials. Chronic care coordinators and the cancer center social worker acted as boundary spanners. The chronic care coordinator role built on medical home infrastructure, applying the chronic care model to cancer care. Coordination from primary care to oncology became more routinized, with information sharing prompted by specific events. These new boundary spanner roles enabled greater coordination around uncertain and interdependent tasks. Recommendations for scaling up include the following: establish systematic approaches to learning from implementation, leverage existing capacity for scalability, and attend to the content and purpose of information sharing.
AldrichH.HerkerD. (1977). Boundary spanning roles and organization structure. Academy of Management Review, 2, 217-230.
2.
AldridgeM. D.HasselaarJ.GarraldaE.van der EerdenM.StevensonD.McKendrickK.. . . MeierD. E. (2016). Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliative Medicine, 30, 224-239.
3.
ArgoteL. (1982). Input uncertainty and organizational coordination in hospital emergency units. Administrative Science Quarterly, 27, 420-434.
4.
BeckerM. C. (2004). Organizational routines: A review of the literature. Industrial and Corporate Change, 13, 643-678.
5.
BerkowitzC.AllenD. H.TenhoverJ.ZulligL. L.RagsdaleJ.FischerJ. E.. . . KoontzB. F. (2017). Knowledge and preferences of primary care providers in delivering head and neck cancer survivorship care. Journal of Cancer Education, 33, 1323-1327.
6.
BickelK. E.McNiffK.BussM. K.KamalA.LupuD.AbernethyA. P.. . . KrzyzanowskaM. K. (2016). Defining high-quality palliative care in oncology practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement. Journal of Oncology Practice, 12, e828-e838.
7.
Bielaszka-DuVernayC. (2011). Vermont’s blueprint for medical homes, community health teams, and better health at lower cost. Health Affairs, 30, 383-386.
8.
BlumenthalD.AndersonG.BurkeS.FulmerT.JhaA. K.LongP. (2016). Tailoring complex-care management, coordination, and integration for high-need, high-cost patients. Washington, DC: National Academy of Medicine.
9.
BrueraE.HuiD. (2012). Conceptual models for integrating palliative care at cancer centers. Journal of Palliative Medicine, 15, 1261-1269.
10.
CannonM. D.EdmondsonA. C. (2005). Failing to learn and learning to fail (intelligently). Long Range Planning, 38, 299-319.
CharmazK. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London, England: Sage.
14.
ClynchN.KellettJ. (2015). Medical documentation: Part of the solution, or part of the problem? A narrative review of the literature on the time spent on and value of medical documentation. International Journal of Medical Informatics, 84, 221-228.
15.
CohenD.McDanielR.CrabtreeB. F.RuheM. C.WeyerS. M.TalliaA. F.. . . StangeK. C. (2004). A practice change model for quality improvement in primary care practice. Journal of Healthcare Management, 49, 155-170.
16.
DamschroderL. J.AronD. C.KeithR. E.KirshS. R.AlexanderJ. A.LoweryJ. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 50. doi:10.1186/1748-5908-4-50
17.
Department of Vermont Health Access. (2015). Vermont Blueprint for Health: 2014 Annual Report. Winooski, VT: Author.
18.
EasleyJ.MiedemaB.BrienM. A.CarrollJ.MancaD.WebsterF.GrunfeldE. (2017). The role of family physicians in cancer care: Perspectives of primary and specialty care providers. Current Oncology, 24, 75-80. doi:10.3747/co.24.3447
19.
EdmondsonA. C. (2012). Teaming: How organizations learn, innovate, and compete in the knowledge economy. San Francisco, CA: Jossey-Bass.
20.
FarmerM.RoseD.RubensteinL.CaneloI.SchectmanG.StarkR.YanoE. (2014). Challenges facing primary care practices aiming to implement patient-centered medical homes. Journal of General Internal Medicine, 29, 555-562.
21.
FliegerS. P. (2017). Implementing the patient-centered medical home in complex adaptive systems: Becoming a relationship-centered patient-centered medical home. Health Care Management Review, 42, 112-121.
22.
GittellJ. H. (2002). Coordinating mechanisms in care provider groups: Relational coordination as a mediator and input uncertainty as a moderator of performance effects. Management Science, 48, 1408-1426.
GrunfeldE.EarleC. C. (2010). The interface between primary and oncology specialty care: Treatment through survivorship. JNCI Monographs, 2010(40), 25-30.
26.
HanP. K. J.RaysonD. (2010). The coordination of primary and oncology specialty care at the end of life. Journal of the National Cancer Institute: Monographs, 2010(40), 31-37.
27.
HoffT. (2010). The patient-centered medical home: What we need to know more about. Medical Care Research and Review, 67, 383-392.
28.
HoffT. (2013). Medical home implementation: A sensemaking taxonomy of hard and soft best practices. Milbank Quarterly, 91, 771-810.
29.
HuntC. M.SpenceM.McBrideA. (2016). The role of boundary spanners in delivering collaborative care: A process evaluation. BMC Family Practice, 17, 96. doi:10.1186/s12875-016-0501-4
30.
Institute of Medicine, National Cancer Policy Board, & Committee on Cancer Survivorship: Improving Care and Quality of Life. (2005). From cancer patient to cancer survivor: Lost in transition. Washington, DC: National Academies Press.
31.
KilbourneA. M.NeumannM. S.PincusH. A.BauerM. S.StallR. (2007). Implementing evidence-based interventions in health care: Application of the replicating effective programs framework. Implementation Science, 2(1), 42. doi:10.1186/1748-5908-2-42
32.
KlabundeC. N.HaggstromD.KahnK. L.GrayS. W.KimB.LiuB.. . . KeatingN. L. (2017). Oncologists’ perspectives on post-cancer treatment communication and care coordination with primary care physicians. European Journal of Cancer Care, 26(4). doi:10.1111/ecc.12628
33.
KousgaardM. B.JoensenA. S.ThorsenT. (2015). The challenges of boundary spanners in supporting inter-organizational collaboration in primary care—a qualitative study of general practitioners in a new role. BMC Family Practice, 16, 17. doi:10.1186/s12875-015-0231-z
34.
LewisV. A.SchoenherrK.FrazeT.CunninghamA. (2016). Clinical coordination in accountable care organizations: A qualitative study. Health Care Management Review, 44, 127-136.
35.
LongJ. C.CunninghamF. C.BraithwaiteJ. (2013). Bridges, brokers and boundary spanners in collaborative networks: A systematic review. BMC Health Services Research, 13(1), 158. doi:10.1186/1472-6963-13-158
36.
MarchJ. G.SimonH. A. (1956). Organizations. New York, NY: Wiley.
37.
McCabeM. S.PartridgeA.GrunfeldE.HudsonM. M. (2013). Risk-based health care, the cancer survivor, the oncologist and the primary care physician. Seminars in Oncology, 40, 804-812.
38.
MeyersD.PeikesD.GenevroJ.PetersonG.TaylorE. F.LakeT.. . . GrumbachK. (2010). The roles of patient-centered medical homes and accountable care organizations in coordinating patient care. Rockville, MD: Agency for Healthcare Research and Quality.
39.
Mora-PinzonM. C.ChrischillesE. A.GreenleeR. T.HoethL.HamptonJ. M.SmithM. A.. . . Trentham-DietzA. (2018). Variation in coordination of care reported by breast cancer patients according to health literacy. Supportive Care in Cancer, 27, 857-865. doi:10.1007/s00520-018-4370-3
40.
NembhardI. M.CherianP.BradleyE. H. (2014). Deliberate learning in health care: The effect of importing best practices and creative problem solving on hospital performance improvement. Medical Care Research and Review, 71, 450-471.
41.
OkhuysenG. A.BechkyB. A. (2009). Coordination in organizations: An integrative perspective. Academy of Management Annals, 3, 463-502.
42.
PatruD.LaucheK.van KranenburgH.ZiggersG. W. (2015). Multilateral boundary spanners: Creating virtuous cycles in the development of health care networks. Medical Care Research and Review, 72, 665-686.
RicoR.Sánchez-ManzanaresM.GilF.GibsonC. (2008). Team implicit coordination processes: A team knowledge–based approach. Academy of Management Review, 33, 163-184.
45.
RittenhouseD. R.ShortellS. M.GilliesR. R.CasalinoL. P.RobinsonJ. C.McCurdyR. K.SiddiqueJ. (2010). Improving chronic illness care: Findings from a national study of care management processes in large physician practices. Medical Care Research and Review, 67, 301-320.
46.
SadaY. H.StreetR. L.Jr.SinghH.ShadaR. E.NaikA. D. (2011). Primary care and communication in shared cancer care: A qualitative study. American Journal of Managed Care, 17, 259-265.
47.
SafranD. G.MillerW.BeckmanH. (2006). Organizational dimensions of relationship-centered care: Theory, evidence, and practice. Journal of General Internal Medicine, 21, S9-S15.
48.
SolimeoS. L.OnoS. S.LampmanM. A. M.PaezM. B. W.StewartG. L. (2015). The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran’s health administration. Journal of Interprofessional Care, 29, 26-33.
49.
ThompsonJ. D. (1967). Organizations in action: Social science bases of administrative theory. New York, NY: McGraw Hill.
50.
TomasoneJ. R.BrouwersM. C.VukmirovicM.GrunfeldE.O’BrienM. A.UrquhartR.. . . FitchM. (2016). Interventions to improve care coordination between primary healthcare and oncology care providers: A systematic review. ESMO Open, 1(5), e000077.
51.
Tomoaia-CotiselA.FarrellT. W.SolbergL. I.BerryC. A.CalmanN. S.CronholmP. F.. . . MagillM. K. (2018). Implementation of care management: An analysis of recent AHRQ research. Medical Care Research and Review, 75, 46-65.
52.
TsuiJ.HudsonS. V.RubinsteinE. B.HowardJ.HicksE.Kieber-EmmonsA.. . . CrabtreeB. F. (2018). A mixed-methods analysis of the capacity of the patient-centered medical home to implement care coordination services for cancer survivors. Translational Behavioral Medicine, 8, 319-327.
53.
TushmanM. L. (1977). Special boundary roles in the innovation process. Administrative Science Quarterly, 22, 587-605.
WeaverS. J.CheX. X.PetersenL. A.HysongS. J. (2018). Unpacking care coordination through a multiteam system lens: A conceptual framework and systematic review. Medical Care, 56, 247-259.
56.
WeaverS. J.JacobsenP. B. (2018). Cancer care coordination: Opportunities for healthcare delivery research. Translational Behavioral Medicine, 8, 503-508.
57.
WilliamsP. (2002). The competent boundary spanner. Public Administration, 80, 103-124.
58.
YinR. K. (2009). Case study research: Design and methods (4th ed.). Thousand Oaks, CA: Sage.
59.
ZackrisonE. J.SeiboldD. R.RiceR. E. (2015). Organizational coordination and communication: A critical review and integrative model. Annals of the International Communication Association, 39, 195-233.
60.
ZuchowskiJ. L.ChrystalJ. G.HamiltonA. B.PattonE. W.ZephyrinL. C.YanoE. M.CordascoK. M. (2017). Coordinating care across health care systems for veterans with gynecologic malignancies: A qualitative analysis. Medical Care, 55(Suppl. 7), S53-S60.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
