The Problem Healthcare is increasingly delivered in an outpatient setting. This shifts responsibility to the patient for the logistics of care superimposed on complex medical and social determinants creating potential disparities in care. Transportation represents a social determinant of health. Barriers in access to outpatient care is especially troubling in the field of radiation oncology. The protracted daily treatment schedule spread across multiple weeks represents an ambulatory medicine crucible for patients with limited transportation and social support.
A radiation treatment regimen can be relatively easy for privileged populations to complete while others find it difficult or impossible to present to the clinic on a regular basis over several weeks of treatment. Previously, interruptions in planned treatment were broadly labeled as noncompliance, connoting personal failure on the part of the patient. As we evolve into an era of population health, it is incumbent on change leaders to ensure that the responsibility for access and treatment completion is shifted from the patient to the healthcare system and to the community. This requires a deeper understanding of the complex factors contributing to the access disparity phenomenon and new solutions.
Given the difficulties associated with an extended daily treatment regimen a certain level of treatment noncompliance has been expected, and ultimately accepted. However, delays and interruptions in radiation treatment can negatively impact the ability to control disease. It was clear to our team that failure to meet the logistical burden associated with radiation treatment regimens represents an important preventable cause of disparities in oncology outcomes.
High capital and operational costs restrict the geographic availability of radiotherapy to a limited number of facilities. In many communities, all patients are served by a single radiation oncology clinic. Cone Health operates one of the busiest radiation treatment facilities in the North Carolina, treating over 120 patients per day with four linear accelerators. Certified by the American College of Radiology (ACR) as a top performing radiation oncology department, the team strives to provide exceptional care to the community. However, noneof the current ACR quality of care metrics track treatment compliance or disparities of care. So, wicked problems may flourish, even under the guidance of the well intentioned ACR, when a diverse community is expected to adapt to the procedures of a complex health system. The central North Carolina Triad community is economically and racially diverse with sizeable