COVID-19 Pandemic and Fragmentation of Care
Due to the COVID-19 pandemic, head and neck care coordination has been
dramatically altered. In these uncertain times, limitations with
clinical resources and healthcare office availability have made it more
difficult for head and neck cancer patients to obtain multidisciplinary
care. In the usual timeframe, a new head and neck cancer patient would
be able to meet all the members of the MDT, finish pre-treatment
diagnostic studies, and receive a consensus MDC recommendation within
the span of about two to three weeks. In the current scope of
telemedicine, there is concern for possible delays along any of these
timepoints as well as the time-interval from diagnosis to treatment
initiation. The ability of MDT and MDC to modify care coordination is
essential in a time of crisis. The MDT framework allows patients to be
referred in a timely fashion between a network of specialty providers;
this way patients from regions of low resource availability (i.e.
personnel, equipment, operating room availability) can be guided to
areas which are able to deliver timely oncologic care. The MDC is
fundamental to this care coordination model.
At our institution, the University of Pittsburgh Medical Center, there
are multiple distant hospital campuses spread out across three states,
Pennsylvania, New York, and Maryland (Figure 1). New patients may be
referred to the head and neck MDT from any of these locations. However,
it is often that such patients may see a local primary care physician or
general otolaryngologist before being referred for evaluation by the
UPMC Head and Neck MDT. Due to the COVID-19 pandemic, any delays which
are associated with this pathway are likely to be exacerbated. In the
past few weeks, the MDT has adopted hosting a virtual MDC which is
accessible to remote UPMC locations away from Pittsburgh, PA. The
concept is to streamline head and neck oncologic care such that patients
in any region of the hospital system would be able to obtain timely
diagnosis and treatment plans. The virtual MDC offers flexibility for
both providers and patients. Regardless of whether patients are awaiting
an initial MDT evaluation or definitive treatment, MDC discussions
empower patient-centric care so that current needs are matched in an
appropriate fashion with available system resources.