Qualitative Study of Interprofessional Collaboration in Radiation Oncology Clinics: Is There a Need for Further Education?

PURPOSE: Interprofessional education (IPE) is gaining recognition as a means of improving health care delivery and patient outcomes. A primary goal of IPE is improved interprofessional collaboration (IPC). The multidisciplinary team in the radiation oncology clinic requires effective IPC for optimal delivery of radiation therapy. However, there are limited data on IPE and IPC in radiation oncology. This qualitative study aims to characterize IPC in radiation oncology. METHODS AND MATERIALS: Semistructured phone interviews were performed from June to August 2019 with radiation oncologists, nurses, dosimetrists, radiation therapists, medical physicists, and medical students across a single academic medical center and affiliated network sites. Interviews were recorded, de-identified, and transcribed verbatim. Resulting transcripts were analyzed using thematic analysis. RESULTS: Seventeen interviews were performed with 4 radiation oncologists, 2 nurses, 2 dosimetrists, 4 radiation therapists, 2 medical physicists, and 3 medical students. Thematic analysis identified 4 themes: (1) management of the radiation oncology clinic, (2) potential impact of interprofessional training in radiation oncology, (3) current climate of interprofessional education in radiation oncology, and (4) creating an interprofessional training program in radiation oncology. Each theme elicited between 2 and 7 subthemes. CONCLUSIONS: From the analytical themes that emerged, it is hypothesized that misunderstanding professionals' roles can lead to communication breakdown, which creates less efficient clinic management and disorganized patient care. Although other medical professionals shadow physicians during their training, physicians are not learning about other professions in the same way. Interviewees from each professional category recommend a formal shadowing program for radiation oncology trainees at the medical student or resident level. Having structured opportunities for IPE is important given competing demands of learners during medical student rotations and residency. This study suggests an unmet need for exposure of radiation oncology medical trainees to IPE with the ultimate goal of improving IPC in the radiation oncology clinic.

Assessing the Efficacy of Certificate of Need Laws Through Total Joint Arthroplasty.

ABSTRACT: Lawmakers suggest Certificate of Need (CON) laws' main goals are increasing access to healthcare, increasing quality of healthcare, and decreasing healthcare costs. This retrospective database study aims to evaluate the effectiveness of CON through analysis of total knee, hip, and shoulder arthroplasty (TKA, THA, and TSA, respectively). A review was performed using the Humana Insurance PearlDiver national database from 2007 to 2015. Access to care was approximated by the rates of total joint arthroplasty (TJA) in patients diagnosed with arthritis to the corresponding joint. The quality of care was assessed using complication rates after TJA. The total cost of TJA was approximated from average reimbursement to the healthcare facility per procedure. Patients in states without CON programs received TKA, THA, and TSA more frequently (p < .0001, p = .250, p = .019). No significant difference was found in studied complication rates between CON and non-CON states. Similarly, there was no trend found when comparing the cost of each procedure in CON versus non-CON states. These findings are consistent with other recent studies detailing the impact of CON regulation on THA and TKA. The apparent nonsuperiority of CON states in achieving their purported goals may call into question the effectiveness of additional bureaucracy and regulation, suggesting a need for further examination.