Triaging Support: A Pilot Supportive Care Referral Program Using Automated TriggersWithin the Athena Breast Health Network Screening System at the University of California San Francisco Breast Care Center

• Published in: Psycho-oncology (Chichester, England) England), 2014-02, Vol.23, p.23
• Main Authors: Shumay, Dianne, Solomon, Alexandra, Kendall, Paige, Henderson, Timothy, Hamolsky, Debby, Wheelock, Alyse, Melisko, Michelle
• Format: Article
• Language: English
• Subjects: Breast cancer; Electronic health records; Health care delivery; Medical screening; Oncology; Psychiatry; Quality of care
• ISSN: 1057-9249; 1099-1611

In addition to distress screening, best practices call for cancer centers to refer, follow-up and monitor efforts to address unmet psychosocial needs. The current study analyzes the first 3 months of screening and supportive care referrals in this pilot program at the UCSF Breast Care Center (BCC). UCSF is part of the Athena Breast Health Network, a system of breast care across the 5 UC medical centers. The Athena Health Questionnaire System supports discrete data capture, branching and skip logic, versioning, and interfacing with EMR and web services. Prior to their appointment, patients complete an Athena web-based survey of health history, current symptoms and psychological functioning. The study team met with breast clinicians, Athena Network experts, and representatives of the various supportive care services at UCSF to adapt the intake questionnaire to add needs assessments and establish triaging criteria for referral to Psycho-oncology, Onco-fertility, Genetic Counseling, Smoking Cessation, Social Work and Peer Support programs. After a phased implementation period, patients meeting threshold criteria triggered orders in the EMR for clinician referral to supportive care services. Patients were given the option to consent for their data to be used in research. A total of 607 patients completed the survey since December 2012, with approximately 90% giving consent for data to be used for research. After a phased implementation of the triage and referral process, 192 patients were screened and gave consent during the 3-months of the study period. Mean age was 52.6(±13.7) and nearly 25% were of non-white ethnicities. 67.3% triggered at least one referral to a support service, with 48.5% referred to genetic counseling, 30% to peer support, 12.4% to social work, 6.7% to psycho-oncology, 2.4%to onco-fertility and 2.4% to smoking cessation. A web-based screening system can be used to triage patients to supportive care services within the EMR, and for adjusting thresholds for highest sensitivity and specificity. As follow-up surveys are rolled out, patients who have met thresholds can be followed longitudinally and documented in the EMR, whereas symptoms, distress and needs can be monitored for outcomes. This study provides information of relevance to researchers in distress screening, health policy and service delivery areas. The system described here may be useful to study alternative models of triage and supportive care and for screening patients for entry