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Abstract Background According to a landmark study by the Institute of Medicine, patients with cancer often receive poorly coordinated care in multiple settings from many providers. Lack of coordination is associated with poor symptom control, medical errors, and higher costs. Purpose The aims of this systematic review and meta-analysis were to (1) synthesize the findings of studies addressing cancer care coordination, (2) describe study outcomes across the cancer continuum, and (3) obtain a quantitative estimate of the effect of interventions in cancer care coordination on service system processes and patient health outcomes. Methods Of 1241 abstracts identified through MEDLINE, EMBASE, CINAHL, and the Cochrane Library, 52 studies met the inclusion criteria. Each study had US or Canadian participants, comparison or control groups, measures, times, samples, and/or interventions. Two researchers independently applied a standardized search strategy, coding scheme, and online coding program to each study. Eleven studies met the additional criteria for the meta-analysis; a random effects estimation model was used for data analysis. Results Cancer care coordination approaches led to improvements in 81 % of outcomes, including screening, measures of patient experience with care, and quality of end-of-life care. Across the continuum of cancer care, patient navigation was the most frequent care coordination intervention, followed by home telehealth; nurse case management was third in frequency. The meta-analysis of a subset of the reviewed studies showed that the odds of appropriate health care utilization in cancer care coordination interventions were almost twice (OR = 1.9, 95 % CI = 1.5–3.5) that of comparison interventions. Conclusions This review offers promising findings on the impact of cancer care coordination on increasing value and reducing healthcare costs in the USA.

Introduction Randomized clinical trials have demonstrated the efficacy of antiretroviral pre‐exposure prophylaxis (PrEP) in preventing HIV acquisition among men who have sex with men (MSM). However, limited research has examined initiation and adherence to PrEP among Black MSM (BMSM) in the United States (US) who are disproportionately represented among newly HIV infected and late to care individuals. This research reports on the HIV Prevention Trials Network 073 (HPTN 073) study aimed to examine PrEP initiation, utilization and adherence among Black MSM utilizing the theoretically principled, culturally informed and client‐centered care coordination (C4) model. Methods The HPTN 073 study enrolled and followed 226 HIV‐uninfected Black MSM in three US cities (Los Angeles, CA; Washington DC; and Chapel Hill, NC) from February 2013 through September 2015. Study participants were offered once daily oral emtricitabine/tenofovir (FTC/TDF) PrEP combined with C4 and followed up for 52 weeks. Participants received HIV testing, risk reduction education and clinical monitoring. Results Of the 226 men enrolled, 178 participants initiated PrEP (79%), and of these 64% demonstrated PrEP utilization at week 26 (mid‐point of the study) based on pharmacokinetic testing. Condomless anal sex with an HIV‐infected or unknown status casual male partner was statistically significantly associated with a greater likelihood of PrEP initiation (adjusted odds ratio (OR) 4.4, 95% confidence interval (CI) 1.7, 11.7). Greater age (≥25 vs. <25, OR 2.95, 95% CI 1.37 –6.37), perception of having enough money (OR 3.6, 95% CI 1.7 to 7.7) and knowledge of male partner taking PrEP before sex (OR 2.22, 95% CI 1.03 to 4.79) were statistically significantly associated with increased likelihood of PrEP adherence at week 26. Annualized HIV incidence was 2.9 (95% CI 1.2 to 7.9) among those who initiated PrEP, compared to 7.7 (95% CI 2.5 to 24.1) among those who did not initiate PrEP (p = 0.18). Conclusions Results suggest a high level of PrEP initiation among at‐risk Black MSM, a group historically characterized as hard to reach. The data support the importance of addressing contextual factors that affect PrEP initiation and adherence, and of additional research on the ultimate benefit of PrEP in HIV prevention among Black MSM.

At the end of year 2018, it was estimated that in the United States over 1 million people were living with HIV. Although Black/African American individuals comprise an estimated 13.4% of the US population, as of 2019, they represented an estimated 42% of all new HIV diagnoses in 2018. PrEP use among Black men who have sex with men has not reached levels sufficient to have a population impact on HIV incidence. The purpose of this study was to examine whether high perceived autonomy support and care coordination quality were associated with PrEP continuation. Secondary analyses were conducted on data with 226 Black MSM in three US cities. Participants who were PrEP users and scored higher on autonomy support at week 8 were significantly more likely to continue PrEP (OR 1.48; 95% CI 1.04–2.11). Perception of coordination quality did not differ between PrEP users and non-users at any of the visits. Although coordination quality was not statistically significant, greater than half of PrEP users and non-PrEP users utilized the C4 services. Addressing social, individual, and structural barriers to PrEP may benefit Black MSM irrespective of their PrEP use.

Discharge planning is an important aspect of healthcare to ensure continuity of patient care after hospital discharge. Normalization Process Theory (NPT) has been used to understand how discharge planning interventions can be implemented effectively in clinical practice. This review aimed to explore the use of Normalization Process Theory (NPT) in patient discharge planning and how this theory is applied in various healthcare contexts. A systematic review was conducted using the PRISMA method, using four international databases: PubMed, Scopus, Taylor & Francis, and EBSCO-host. Articles were selected based on inclusion criteria and evaluated using JBI Critical Appraisal Tools and MMAT. The keywords used were patient discharge OR patient transfer/organization and administration OR discharge plan OR patient transfer OR discharge planning AND Normalization process theory OR normalization process model OR NPT OR NPM. The analysis was carried out using descriptive qualitative and thematic analysis. A total of 8 articles that fulfilled the criteria were included in the analysis. The results suggest that implementing NPT enhances the discharge planning process and facilitates the development of more effective intervention models. NPT was utilized as a framework for data collection, coding, and analysis of the discharge planning implementation process. In addition, NPT is associated with improved coordination among healthcare workers, more effective psychosocial support for families, and increased patient compliance with treatment. The application of NPT inpatient discharge planning allows a deeper understanding of the factors that influence the successful implementation of interventions. The use of NPT in research can help improve the quality of discharge planning by considering aspects of team coordination, patient support, and the effectiveness of evidence-based interventions.

Objective To provide a comprehensive state‐of‐the‐art review from the perspective of the surgeon and the surgical specialty academies of the conceptual shift from a volume‐driven fee‐for‐service payment model to one of value‐based accountable care payment. This field guide attempts to clarify drivers of surgical value‐based performance and outline a comprehensive strategy to successfully engage this healthcare reform paradigm. Data Source Pubmed/MEDLINE/Google search. Review Methods Pubmed/MEDLINE/Google search was performed during June 1, 2024–May 17, 2025 for value‐based initiatives, administrative, and government agency publications, Centers for Medicare and Medicaid Services, and Center for Medicare and Medicaid Innovation value‐based care policy, directives, and programs. Conclusions The transition from volume‐based to value‐based payment models necessitates rethinking how surgeons define, quantify, and engage the care they deliver. The social contract between the surgeon and patient is poorly aligned within the current fragmented fee‐for‐service payment model. Relative value units continue to function as a poor benchmark measure of the physician‐patient relationship, which is foundational to achieving consistent patient engagement and favorable clinical outcomes. To facilitate this value‐based realignment within surgical care, we introduce a novel three‐dimensional framework for patient experience management (EM3) focusing on three core elements driving value‐based surgical care: clinical outcomes, patient engagement, and episode‐of‐care spend. EM3 is proposed as a strategic roadmap to operationalize episode‐of‐care transparency within the traditional value equation: Value = Outcomes/Cost. EM3 lays out a comprehensive pathway to facilitate improvements in surgical value‐chain competency, team‐based care leadership, and longitudinal care management skills. These represent the essential core components for competitiveness within a new era of performance metrics relevant to alternative payment arrangements within bundle payments and value‐based referrals. At the academy and peer‐review leadership level, each surgical specialty will need to invest in developing clinically valid next generation assessment measures and care plans encompassing EM3 dimensional elements to remain both relevant and competitive in a new era of evolving accountable care models. We provide a comprehensive summary of the shift from Fee‐for‐Service to Value‐based care. We present a systems based approach (EM3) for surgeons to engage this process. The EM3 framework is a comprehensive strategy for surgeons, surgical specialty academies, and peer review societies to redesign how surgical care is delivered and measured using a value chain approach.

This study aimed to analyze the demand profile and the challenges of regulating access to specialized care, considering the referenced cases and the perspectives of physicians in the Family Health Strategy (FHS). This was a mixed methods study, with a quantitative and qualitative approach, carried out in an inland municipality of the state of Ceará, Brazil. Quantitative data were obtained from Primary Health Care (PHC) referral forms, registered with the regulation center. Focus groups were held, involving 13 FHS physicians. The results showed 643 referrals, the majority (74.2%) corresponded to the request for tests, and 61.6% did not have a diagnostic hypothesis, which corroborates the increase in waiting time. Spine tomography was the exam with the highest amount in relation to the shortest waiting time. Regarding consultation, otorhinolaryngology was the specialty with the highest demand (17.7%). Physicians reported weaknesses and challenges in regulation, such as communication failures and the lack of counter-referral flows, which compromise Primary Health Care coordination, continuity and resolvability. The need to reorganize and qualify the regulatory processes in the municipality is pointed out.

PurposeCare coordination is a strategy to reduce healthcare navigation challenges for cancer patients. The objectives of this study were to assess the association between having a cancer care coordinator (CCC) and long-term health-related quality of life (HRQoL), and to evaluate whether this association differed by level of health literacy.MethodsA population-based sample of survivors diagnosed with breast, prostate, or colorectal cancer in 2015 from the Iowa Cancer Registry participated in an online survey conducted in 2017–2018 (N = 368). Chi-squared tests and logistic regression were used to model the association between patient characteristics and having a cancer care coordinator. Linear regression was used to model the association between patient perception of having a cancer care coordinator and post-treatment physical or mental HRQoL by differing levels of health literacy while controlling for sociodemographic and clinical factors.ResultsMost survivors (81%) reported having one healthcare professional who coordinated their cancer care. Overall, patient perception of having a coordinator was not significantly associated with physical HRQoL (p = 0.118). However, participants with low health literacy (21%) who had a coordinator had significantly higher physical HRQoL scores compared to those who did not (adjusted mean difference 5.2, p = 0.010), while not so for medium (29%) or high (51%) health literacy (p = 0.227, and p = 0.850, respectively; test for interaction p = 0.001). Mental HRQoL was not associated with having a coordinator in our analyses.ConclusionFindings suggest that care coordinators improved post-treatment physical HRQoL, particularly for participants with low health literacy. Care coordinators may be beneficial to the most vulnerable patients struggling to navigate the complex healthcare system during cancer treatment. Future research should focus on the mechanisms by which care coordination may affect post-treatment HRQoL.

This thesis aimed to contribute to a better understanding of what integrated primary care is, and how it can be achieved by focussing on the collaboration processes that underlie the development of integrated primary care. The first part of this thesis operationalized the concept of integrated care from a primary care perspective. The second part of this thesis described the collaboration mechanisms among integrated care projects that were part of a national integrated primary care study in The Netherlands.

Background Healthcare coordination and continuity of care conceptualize all care providers and organizations involved in health care to ensure the right care at the right time. However, systematic evidence synthesis is lacking in the care coordination of health services. This scoping review synthesizes evidence on different levels of care coordination of primary health care (PHC) and primary care. Methods We conducted a scoping review of published evidence on healthcare coordination. PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science and Google Scholar were searched until 30 November 2022 for studies that describe care coordination/continuity of care in PHC and primary care. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to select studies. We analysed data using a thematic analysis approach and explained themes adopting a multilevel (individual, organizational, and system) analytical framework. Results A total of 56 studies were included in the review. Most studies were from upper-middle-income or high-income countries, primarily focusing on continuity/care coordination in primary care. Ten themes were identified in care coordination in PHC/primary care. Four themes under care coordination at the individual level were the continuity of services, linkage at different stages of health conditions (from health promotion to rehabilitation), health care from a life-course (conception to elderly), and care coordination of health services at places (family to hospitals). Five themes under organizational level care coordination included interprofessional, multidisciplinary services, community collaboration, integrated care, and information in care coordination. Finally, a theme under system-level care coordination was related to service management involving multisectoral coordination within and beyond health systems. Conclusions Continuity and coordination of care involve healthcare provisions from family to health facility throughout the life-course to provide a range of services. Several issues could influence multilevel care coordination, including at the individual (services or users), organizational (providers), and system (departments and sectors) levels. Health systems should focus on care coordination, ensuring types of care per the healthcare needs at different stages of health conditions by a multidisciplinary team. Coordinating multiple technical and supporting stakeholders and sectors within and beyond health sector is also vital for the continuity of care especially in resource-limited health systems and settings.

The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.