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Article Title

High-Risk Breast Cancer Clinic –– A New Risk-Stratified, Evidence-Based, and Efficient Patient Care Model

Publication Date

8-15-2016

Keywords

breast cancer, risk

Abstract

Background/Aims: There is considerable variation in adherence to available evidence-based recommendations for risk assessment, screening, genetic counseling and testing, surveillance and preventive care for women at risk for breast cancer. To improve adherence and patient outcomes and to facilitate appropriate referral to genetic testing, Geisinger implemented a new care model in February 2015 to systematically and efficiently deliver appropriate risk assessment and management services using midlevel providers. This “high-risk breast cancer clinic” provides any interested woman with a personal risk assessment and care plan. Validated risk assessment approaches are used to stratify women into differing risk levels. This new approach focuses on the large moderate-risk (5-year risk ≥ 1.7% and/or lifetime risk ≥ 20%) and average-risk (5-year risk ≤ 1.7%) populations, who comprise the majority of women and who are typically underserved with usual care. It provides them with evidence-based counseling, surveillance and chemoprevention care services. This clinic also serves women with dense breasts (density > 50%, which includes about half of all women) who also are known to be at increased risk for breast cancer.

Methods: For women at moderate risk of developing breast cancer, a decision-analysis model compares care, outcomes and costs for the high-risk breast cancer clinic’s approach to usual care. Assumptions for the model are based on Geisinger patient data, literature and expert opinion to develop estimates for clinical and economic outcomes.

Results: A decision-analysis model comparing Geisinger’s high-risk breast cancer clinic to usual care is used for a budget impact analysis to show the estimated effects of differences in patient care on outcomes and costs, including benefits of delivering risk-based prevention and treatment at earlier stages to moderate-risk patients. This analysis is used to make a business case for this new care model in an integrated health system.

Conclusion: A new targeted care model providing evidence-based evaluation and services to women at moderate and average risk for developing breast cancer offers the potential to improve delivery of appropriate care, patient experience and health outcomes with a favorable impact on cost.

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