Convenience Versus Continuity: A Natural History Study of a Newly Opened Plasma Cell Disorders Clinic in an Underserved Community and Desire for Transfer of Care Among Previously Diagnosed Patients
Authors: Slade Michael , Vij Ravi , Stockerl-Goldstein Keith , Schroeder Mark A. , Vickroy Angela , Kavanaugh Margaret , Wilson Carmen , Fiala Mark 
Published: December 2024

Receipt of subspecialty care at an NCI-designated cancer center (NCI-CC) is associated with improved

patient outcomes (Wolfson et al, Cancers 2016). However, only 45% of patients live within 1 hour of an

NCI-CC. One solution to improve access is to open satellite locations in underserved areas, with the

assumption that newly diagnosed patients will prefer care close to home. However, no data is available

on the impact of this approach on previously diagnosed patients within an NCI-CC-associated health

system. While some patients may prefer the convenience of a local clinic, other patients may be reluctant

to switch providers. Our institution recently opened a new clinic focused on plasma cell dyscrasias in an

underserved area. We performed a structured intervention to identify patients living in this community

and traveling to other locations for care, with the goal of offering them the opportunity to transition to

the newly opened clinic.

Patients were considered eligible for transfer if 1) they were receiving care for a plasma cell dyscrasia from

a specialist at our facility, 2) they lived within the satellite clinic catchment area and 3) treating team

determined the patient was appropriate for transition of care. In borderline cases, door-to-door time was

determined using Google Maps and patients were included if the time to the satellite clinic was less than

or equal to their current location. Clinic lists were screened weekly from August to December 2024 via

the electronic medical record. Lists of eligible patients were sent to the treating physician, who

determined if patient was appropriate to approach for transfer. The current clinical team offered

appropriate patients transition of care at a regularly scheduled visit. Patient transfers were tracked and

qualitative reasons for decision regarding transfer were determined via discussion with the treating team.

We identified 62 eligible patients among 3 providers for potential transfer. After screening, 28 patients

(45%) were excluded from potential transfer. Cited reasons to exclude patients by the treating team

included study participation (n = 6), planned return to referring physician (5), medical instability (2) and

current therapy not available at satellite clinic (2). 13 patients (21%) were excluded due to existing

relationships with treating team and were marked as “provider discretion.” Of the remaining 34 patients,

10 patients (29%) decided to transfer their care to the satellite clinic and are currently still receiving their

care at that location. 24 patients (71%) were approached and declined to transfer their care. Reasons for

declining transfer included comfort with current team (n= 10), superior convenience at current location

due to work or family responsibilities (7) and concern regarding quality of care at the new facility (2). Five

patients did not identify a specific reason for declining transfer.

Our report provides pilot data that a structured intervention to approach previously diagnosed patients

within a cancer center network and offer them transfer to a newly formed subspecialty clinic closer to

home is acceptable to both patients and providers. Approximately half of identified patients were

classified as acceptable for transfer by their current clinical teams, with 46% of ineligible patients being

excluded due to provider preference. Further, while most patients elected not to transfer, 29% of

approached patients found the convenience of a clinic within their community valuable enough to switch

clinical care teams. The most commonly cited reason for declining transfer was connection with current

team (53%), emphasizing importance of directing newly referred patients to satellite locations if

appropriate.