Two-year outcomes following the HIDOC program: expanding outpatient care delivery to meet the needs of medically complex, high-utilizing patients with a broader interprofessional care team.

This article describes the Highly Individualized Dedicated Onsite Care (HIDOC) intensive primary care program implemented at a university clinic, comprising (a) care by an interprofessional team, (b) new logistical capacity, and (c) clinician skills training. Measured outcomes include Emergency Department (ED) visits and hospitalizations at a university and a community hospital over 2 years, using a within-subjects design. We demonstrate decreased hospitalizations at the University Hospital, and a decrease in ED visits at both sites. Team-based strategies to provide intensive primary care can decrease utilization, allowing for greater continuity of care.

Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors.

PURPOSE/OBJECTIVES: To examine the sources of uncertainty in older African American and Caucasian long-term breast cancer survivors by focusing on frequency of triggers of uncertainty about cancer recurrence and physical symptoms linked to long-term treatment side effects. DESIGN: In the context of a larger randomized, controlled treatment-outcome study, data were gathered from 10 monthly follow-up telephone calls by nurses. SETTING: Rural and urban regions of North Carolina. SAMPLE: 244 older women (mean age = 64 years); 73 African American women and 171 Caucasian women who were five to nine years after breast cancer diagnosis. FINDINGS: The most frequent triggers were hearing about someone else's cancer and new aches and pains. The most frequent symptoms were fatigue, joint stiffness, and pain. Although no ethnic differences occurred in the experience of symptoms, Caucasian women were more likely than African American women to report that their fears of recurrence were triggered by hearing about someone else's cancer, environmental triggers, and information or controversy about breast cancer discussed in the media. CONCLUSIONS: Illness uncertainty persisted long after cancer diagnosis and treatment, with most women experiencing multiple triggers of uncertainty about recurrence and a range of symptoms and treatment side effects. IMPLICATIONS FOR NURSING: Nurses can help cancer survivors to identify, monitor, and manage illness uncertainty and emotional distress.