Impact of a care delivery intervention for patients with socioeconomic disadvantages, in their preferred language of English or Spanish.
Authors: Weldon Christine B. , Khan Sarah , Trosman Julia R. , Valentine Tierra , Hernandez Jorge , PADURI SWETHA , Reddy Vijay Ketan , Sakhuja Anuradha , Czarnowski Daniel , Patel Twinkle , Ramirez Sandra , Oliveras Margarita , Williams Emilia , Valecha Gautam , Kassem Mohammed Azher , Sharma Jaya , Subramanian Seshan , Ravelo Arliene , Khosla Paramjeet Grewal 
Published: September 2024

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Background:
Sinai Health System’s oncology program serves Chicago’s inner city patients with substantial needs for social and primary care, many of whom prefer communication in Spanish. Sinai has implemented a care delivery intervention to address these needs, using the 4R Oncology Model for patient-facing care planning and patient self-management. 4R (Right Info/Care/Patient/Time) has shown significant improvements in the timeliness of care cancer delivery and referrals to cancer care (1). Herein, we implemented the 4R intervention to improve the timeliness of care delivery and referrals to care, focusing on the social and primary care needs of Sinai patients.
Methods:
Evaluation was conducted by surveying historical control and intervention (4R) cohorts of patients in their preferred language of Spanish or English. The 4R cohort received care at a Sinai medical oncology clinic Apr 2023 - Jan 2024. Control cohort received care Jan 2023 – March 2023. Analyses were conducted using Fisher’s exact test.
Results:
Survey response rates: 76% (38/50) in control and 75% (33/44) in 4R cohorts. Participant characteristics were comparable between control and 4R cohorts, respectively: 55%, 58% Hispanic, 42%, 39% Black; 76%, 82% high school education or less; 87%, 97% < 30k income; 50%, 55% preferred language Spanish; 47%, 45% English. For the total cohorts, all 5 metrics improved between control and 4R, and 4 of the 5 metrics improved significantly (Table). Among Spanish-preferred patients, 3 of the 5 metrics improved significantly, while improvements among English-preferred patients were not statistically significant. Both language groups saw numerical, but not statistically significant improvement in receiving referrals to primary care and meeting all their practical and family needs.
Conclusions:
The 4R Oncology intervention resulted in significant improvement in time to treatment and referrals to social and primary care in our population of socioeconomically disadvantaged patients with high needs for these services. Patients preferring Spanish benefited at a higher rate than English-preferring patients, indicating that 4R may be an effective method to address the needs of this important patient group. Future efforts will further optimize 4R to address remaining gaps for this group, as well as to improve the delivery of this care for the English-preferred patients. 1. Trosman JCO OP 2021.

Metric
Control Total %N=38
4R Total %N=33
Control Spanish %n=19
4R Spanish %n=18
Control English %n=19
4R English %n=15

Started treatment within 6 weeks of diagnosis
61

88*

53

94*

68
80

Received referral to primary care
66

82*

74
83
58
80

Received referral to support for transportation, food, and other needs
68

85*

63

89*

74
80

Referred to help and resources to help pay for care
50

67*

47

78*

53
53

All of my practical and family needs were addressed
86
89
84
89
87
87

*p<0.1 comparing control and 4R cohorts.