A Population Care Management Approach within a Vertically Integrated, Community-Based, MULTI-Center Health Care System Promotes Quality Hematopoietic STEM CELL Transplant Survivorship Care

Background:

Through the use of an electronic medical record (EMR) based system, care managers, and single provider physician oversight, we previously reported high concordance rates of post hematopoietic stem cell transplant (HSCT) screening based on ASBMT guidelines in a community based, multi-facility care delivery system.

Objective:

To demonstrate that case management in a vertically integrated, EMR based community practice spanning 9 medical centers in a large metropolitan region can consistently promote high concordance rates with published ASBMT guidelines and lead to timely recognition of common transplant associated complications.

Methods:

Retrospective chart review of 74 consecutive pediatric HSCT survivors (0-18yrs) from 2005-2013 looking for concordance rates with 2012 ASBMT late effects guidelines. The frequency of thyroid dysfunction, cataracts, pulmonary disease, and ovarian dysfunction were noted as well as the mean time to development. Majority of patients were treated with fractionated TBI and therefore were at high risk of developing late effects.

Results:

We observed a sustained high level of concordance (>90%) with screening guidelines in the period after a population care management approach was implemented (2009-2013). This led to the timely identification and management of HSCT associated complications.

Conclusion:
An EMR based, vertically integrated health care system facilitates effective community based post-HSCT survivorship care in the pediatric population.