UBC Theses and Dissertations

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UBC Theses and Dissertations

Care coordination among survivors of childhood, adolescent and young adult cancer : patient sharing, healthcare utilization, quality of care, and cost Kaal, Katrin Julia


Background: The provision of long-term follow-up care for the growing population of cancer survivor poses a challenge to health care systems. Survivors of childhood, adolescent and young adult cancer have unique risks and needs due to their young age and respective developmental stages at diagnosis and treatment. This thesis addresses the role of primary care and the impact of primary care-based care coordination in the long-term follow-up care for survivors of childhood, adolescence and young adult cancer. Methods: This thesis includes a scoping review of the literature and a series of population-based studies using data that are part of the Childhood, Adolescent and Young Adult Cancer Survivors (CAYACS) research study, a retrospective cohort study, to assess 1) outpatient healthcare utilization, including patterns of physician visits and primary care-based continuity of care among survivors and sex- and age-matched population comparators; 2) survivor-specific factors associated with healthcare utilization, and 3) the association of care coordination and healthcare utilization (including hospitalization), cost and quality of care among survivors. Results: Survivors had higher rates of health care utilization, differences in patterns of physician visits, and increased numbers of specialist-type practitioners involved in survivors’ care compared to population comparators. Higher visit rates among survivors persisted after taking health status into account. Lower rates of specialist visits in more remote areas and lower probability of high care density for those residing in urban and more densely populated health authority regions (e.g., Vancouver Coastal) were found. The effect of care coordination captured via the care density metric was associated with volume of total visits, cost of care and, for those with the highest level of care density, odds of hospitalization. Conclusion: This research identifies sociodemographic, health system and clinical characteristics associated with healthcare utilization, continuity of and coordination of follow-up care among long-term survivors of childhood, adolescent and young adult cancer. It highlights the importance of care coordination with regard to outcomes such as healthcare utilization and cost of care.

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