Using 4R Care Sequences with Colon Cancer Patients at Lurie Cancer Center

ASCO’s “Criteria for High-Quality Clinical Pathways in Oncology” calls for development of multimodality patient focused pathways. However, clinical pathways are typically created for provider use. The innovative 4R model, developed by the Center for Business Models in Healthcare and Northwestern University, offers an approach for cancer care pathways that empower patients in conjunction with their care team. 4R model is right information and right care for the right patient at the right time. This project will implement the 4R model for a target population of gastric and gastroesophageal junction (GEJ) cancer patients and care teams across Northwestern Medicine. 4R will be implemented at each site as a quality improvement, using an adaptation of Edward Deming’s PDSA (Plan-Do-Study-Act). Metrics will be collected prior to the implementation (historical) and after the implementation to assess the impact of the project. The resulting gastric and GEJ care sequences will be reproducible in other settings. The 4R model incorporates the recommendations for patient-centric care pathway plans from the Institute of Medicine, Medicare’s OCM, and National Comprehensive Cancer Network’s guidelines including: multi-modality planning from diagnosis to survivorship or hospice, specifying clinical team and their responsibilities; and inclusion of definitive and supportive cancer care in the plan. Use of 4R Sequences engages the patient and family in a personalized, systematic and effective way. Additionally, the 4R model addresses complexities of cancer care, such as challenges coordinating timing and sequencing of interdependent guideline indicated care events (Taplin et al, JOP 2015).