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A Mixed Method Study Evaluating an Innovative Care Model for Rural Outpatient Breast Surgery Patients

DataNB
DataNB

The care model in Saint John, New Brunswick, supports outpatient mastectomies and lumpectomies, the primary treatments for non-metastatic breast cancer. Given the geographic distribution of the province, many patients travel long distances to receive surgical care at regional hospitals. These patients may face: i) a stressful trip home post-surgery, ii) expensive hotel accommodations; or iii) medically unnecessary hospital stays. Therefore, the Breast Health Program partnered with Delta Hotels by Marriott in Saint John to create the “Delta Oasis” program that offers rural outpatient breast surgery patients and their families’ free accommodations and extramural care. The present study used a mixed-methods approach to investigate patients’ experiences with this program. We found that the program yielded positive benefits for patients, including reduced stress and discomfort associated with travel, and for the Delta Hotels, such as increased customer loyalty and word-of-mouth advertising (i.e., incentives to continue offering the program). Furthermore, there are significant financial implications associated with the Delta Oasis program that could yield health system savings; hotel accommodations are five times less costly than traditional hospital stays for breast surgery perioperative care. The Delta Oasis program is a beneficial alternative to inpatient care that is often not medically necessary for breast cancer surgery. Thanks to the innovative partnership between Saint John’s Breast Health Program and Delta Brunswick Hotel, the Delta Oasis program generates zero cost to the provincial healthcare system. Establishing funding partners and adapting this service to other types of low-risk surgery could bring forth added health system savings.

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A MIXED METHOD STUDY EVALUATING
AN INNOVATIVE CARE MODEL FOR
RURAL OUTPATIENT BREAST SURGERY
PATIENTS
The Delta Oasis Project
Dr. Sharon Chiu, MD1, Samantha Fowler, MA2,3, Sarah Bridges, MAHSR2,3, Natasha Hanson,
PhD2, Jordan King, RN4, Sarah Street, RN5, Dr. Heather Tait, MD5, Karen Irving6, Peggy
McLean6, Lauren McLaughlin, BA2,3, Adrienne Gulliver, MAHSR2,3
1 Department of Surgery, Saint John Regional Hospital, Horizon Health Network
2 Office of Research Services, Horizon Health Network
3 Maritime SPOR SUPPORT Unit
4 Breast Health Program, St. Joseph’s Hospital, Horizon Health Network
5 Breast Health Clinic, The Moncton Hospital, Horizon Health Network
6 Patient Partner
INTRODUCTION
BACKGROUND: OVERVIEW
• Outpatient surgeries are advantageous for patients;
• Minimizes time away from home
• Reduce costs, wait times, and stress
• Patient hotels and similar accommodations are gaining popularity across Canada;
• Alleviate capacity demands and support outpatient care by reducing unnecessary
hospitalizations
• Cost savings compared to traditional hospital stays
• Relation to better patient satisfaction and positive patient health outcomes
Blends evidence-based healthcare and hospitality to provide patients and their supporters a
comfortable atmosphere for rehabilitation
In Saint John, NB, rural breast cancer surgery patients are typically admitted
to the hospital following a mastectomy or breast conserving surgery
Since 51% of NB’s population resides in rural communities, many patients are
forced to stay in hospital as inpatients, pay out-of-pocket to stay at a hotel
nearby, or travel far distances home upon discharge.
BACKGROUND: NEW BRUNSWICK
• Breast Health Program and the Delta Brunswick Hotel developed the Delta Oasis program to give
rural patients one night of free accommodations, including meals, parking, and extramural care.
• Investigated the patient experience from 2015 to 2020
• Quantitively explored effects of the program on patients’ preoperative anxiety and recovery
quality.
• Examined patients’ satisfaction with the program and its impact on perceptions of the Delta
Brunswick.
• Conducted semi-structured interviews to further understand patients’ experiences.
• Patient Partners were engaged during the data synthesis phase.
CURRENT STUDY
METHODS

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A Mixed Method Study Evaluating an Innovative Care Model for Rural Outpatient Breast Surgery Patients

  • 1. A MIXED METHOD STUDY EVALUATING AN INNOVATIVE CARE MODEL FOR RURAL OUTPATIENT BREAST SURGERY PATIENTS The Delta Oasis Project Dr. Sharon Chiu, MD1, Samantha Fowler, MA2,3, Sarah Bridges, MAHSR2,3, Natasha Hanson, PhD2, Jordan King, RN4, Sarah Street, RN5, Dr. Heather Tait, MD5, Karen Irving6, Peggy McLean6, Lauren McLaughlin, BA2,3, Adrienne Gulliver, MAHSR2,3 1 Department of Surgery, Saint John Regional Hospital, Horizon Health Network 2 Office of Research Services, Horizon Health Network 3 Maritime SPOR SUPPORT Unit 4 Breast Health Program, St. Joseph’s Hospital, Horizon Health Network 5 Breast Health Clinic, The Moncton Hospital, Horizon Health Network 6 Patient Partner
  • 3. BACKGROUND: OVERVIEW • Outpatient surgeries are advantageous for patients; • Minimizes time away from home • Reduce costs, wait times, and stress • Patient hotels and similar accommodations are gaining popularity across Canada; • Alleviate capacity demands and support outpatient care by reducing unnecessary hospitalizations • Cost savings compared to traditional hospital stays • Relation to better patient satisfaction and positive patient health outcomes Blends evidence-based healthcare and hospitality to provide patients and their supporters a comfortable atmosphere for rehabilitation
  • 4. In Saint John, NB, rural breast cancer surgery patients are typically admitted to the hospital following a mastectomy or breast conserving surgery Since 51% of NB’s population resides in rural communities, many patients are forced to stay in hospital as inpatients, pay out-of-pocket to stay at a hotel nearby, or travel far distances home upon discharge. BACKGROUND: NEW BRUNSWICK
  • 5. • Breast Health Program and the Delta Brunswick Hotel developed the Delta Oasis program to give rural patients one night of free accommodations, including meals, parking, and extramural care. • Investigated the patient experience from 2015 to 2020 • Quantitively explored effects of the program on patients’ preoperative anxiety and recovery quality. • Examined patients’ satisfaction with the program and its impact on perceptions of the Delta Brunswick. • Conducted semi-structured interviews to further understand patients’ experiences. • Patient Partners were engaged during the data synthesis phase. CURRENT STUDY
  • 7. PARTICIPANTS • Eligible Delta Oasis patients were identified by a nurse navigator based on discharge disposition and proximity to surgical treatment centre (> 100 km away). • Study participants included a retrospective sample of patients who underwent an outpatient breast conserving surgery or mastectomy from 2015 to 2020 at the SJRH and utilized the Delta Oasis program. • Control group of patients who underwent these surgeries at The Moncton Hospital and were discharged to a home more than 100km away were also recruited to participate in the study.
  • 8. • Demographic and Clinical History Questionnaire • Preoperative Anxiety Visual Analog Scale (VAS) • Post-Operative Quality of Recovery Scale (QoR-15) • Delta Oasis Experiences Questionnaire SURVEYS
  • 9. INTERVIEWS • Semi-structured interviews were conducted over the phone by a female clinical research assistant with a graduate education and qualitative research training, following an interview guide. • Interviews were audio recorded and lasted an average of 24 minutes. • Interviews were transcribed verbatim by a member of the research team and then uploaded to NVIVO, a qualitative analysis software. • Interviews were conducted until all interested individuals had an opportunity to participate.
  • 10. • Both the results of the quantitative and qualitative analyses were subsequently discussed and interpreted further by two Patient Partners and clinical team members. • One Patient Partner resided in Saint John at the time of the study and participated in the Delta Oasis program following their breast cancer surgery. • The second Patient Partner resided in Moncton and travelled to their home once discharged from hospital following breast cancer surgery. • Patient Partners shared their lived experience with breast cancer surgery. PATIENT ENGAGEMENT
  • 12. Surveys 34 - Saint John • 25 mastectomy • 9 breast-conserving surgery 18 - Moncton • 13 mastectomy • 5 breast-conserving surgery Interviews 17 - Saint John RESULTS: DEMOGRAPHICS
  • 13. Delta Oasis Program was a positive experience (17/17 participants) • Staff treated them well and were accommodating (16/17) • Positively influenced perception of the Delta hotels and increased likelihood to recommend and stay there (16/17) • Food and accommodations were great (16/17) • Hotel stay was relaxing and was a break from their daily routine (9/17) • Some mentioned reduced financial burden (5/17) RESULTS: QUALITATIVE
  • 14. We asked the participants directly if the program had an effect on their surgery and recovery experiences • 13/17 said staying at the Delta had a positive effect on surgery & recovery experiences We also asked the participants if there were any improvements that could be made to the Delta Oasis program • 10 participants had no suggestions for improvement to the program • 15 said the program should be expanded to other regions or types of surgery RESULTS: QUALITATIVE
  • 15. Healthcare Related Themes: • Recovery from surgery went well (16/17) • Positive experiences with healthcare providers (15/17) • Emotional about cancer diagnosis and surgery (15/17) • Used to travelling for healthcare (15/17) • Felt OK about upcoming surgery (11/17) RESULTS: QUALITATIVE
  • 16. • All participants (except one) stayed the night of their surgery. • Several also stayed the night before (9). • Quality of sleep was fair to good both nights. • Most participants took advantage of complimentary dinner (29) and breakfast (29) and recalled the quality being good or very good. • All participants were accompanied by someone, usually their spouse or partner (23). • No participants reported any health problems during their stay. RESULTS: QUANTITATIVE
  • 17. • All participants (except one missing response) indicated they were likely (2) or very likely (31) to recommend the program to others • Most participants indicated that the program increased or greatly increased their likelihood of staying at the Delta again (27) • Also increased their likelihood of recommending the hotel to others (29) RESULTS: QUANTITATIVE
  • 18. RESULTS: QUANTITATIVE • Results of ANOVAs did not show differences between the Delta Oasis group and control group on pre-operative anxiety or quality of recovery. • Small sample size but descriptive statistics also suggest the lack of a difference.
  • 20. IMPLICATIONS • High satisfaction reported by program participants is consistent with other reported patient hotel experiences. • Patients appreciated having family members at the hotel post-operation, also expressed in related studies. • Help reduce the burden of care often felt by family members of breast surgery patients. • Time spent traveling long distances for appointments and procedures could strain family dynamics since women disproportionately carry the load of “care work”. The Delta Oasis program may relieve gendered caregiving paradoxes. • Beneficial financial implications could yield health system savings.
  • 21. • Expand upon the current study by conducting a prospective analysis of the cost-benefits and patient experience associated with the Delta Oasis program. • Investigate potential for expanding the program to include other low-risk surgical cohorts across provincial health zones. FUTURE DIRECTIONS