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  • 7/21/2019 Transforming Health Systems to Meet the challenge of Breast Cancer and Chronic Care: A Diagonal Approach

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    Agmcech Bhrcg Iohum

    hrvhrf Dmjnhm Gqucty Coctchtcvg

    hrvhrf Bgfcehm Ue`jjm

    mjnhm Vhsi Ajreg jo Gxphofgf Heegss tj hoegr hrg hof jotrjm

    gxceho @ghmt` Ajuofhtcjo

    !"htgmj h #ge`jocjo %jr Cotgrohtcjohm hoegr jotrjm &$C'

    rhos%jr"co( @ghmt` Uystg"s tj Bggt t`g`hmmgo(g j% )rghst hoegr hof `rjoce hrg*+ch(johm Hpprjhe`

    ghst Ehoegr co t`g Hrhn TjrmfBhre` >5, >;879 Hbbho, Ljrfho

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    Gvcfgoeg-nhsgfHfvjehey

    Hfvjehey-cospcrgfGvcfgoeg

    Hetcjo;;0

    Luog, >;;4

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  • 7/21/2019 Transforming Health Systems to Meet the challenge of Breast Cancer and Chronic Care: A Diagonal Approach

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    Arj" hogefjtg,

    , tj gvcfgoeg

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    Dmjnhm Vhsi Ajreg jo Gxphofgf

    Heegss tj hoegr hrg hof jotrjm

    co +gvgmjpco( juotrcgs

    - (mjnhm `ghmt` . ehoegr ehrg

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    DVA/* h @hrvhrf $ocvgrscty;I@A #hrtogrs`cp

    Ajtj* 8ct` H"hofh )gr(gr tj 8`j" t`g njji cs fgfcehtgf

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    mjsco( t`g hoegr +cvcfg*Ho Gqucty C"pgrhtcvg

    C* U`jumfng fjog

    CC* Ejumf ng fjogCCC* Eho ng fjog

    B>/ $oogegsshry

    B5/ $oh%%jrfhnmg

    B6/ C"pjsscnmg

    B7* Cohpprjprchtg

    Gxphofco( heegss tj ehoegr ehrg hof ejotrjm co 1BCs*

    8< Coojvhtcvg Fgmcvgry

    >< Heegss< Haajrfhnmg Bgfs, Qheecogs & Vge`s5< Coojvhtcvg Acohoeco< Fj!gstce hof "mjnhm

    #< $vcfgoeg ajr Fgecscjo%Bhco

    '< (tg)hrfs`c* hof +ghfgrs`c*

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    Ehoegrs coerghscodm jom j! t`g "jjr, hrg

    ojt t`g jom ehoegrs h!!getcod t`g "jjr

    MBCEs heejuot ajr ?3;% ja egrvcehm hof 4;% ja

    nrghst ehoegr fght`s. Njt` hrg mghfcod icmmgrs

    gsgechmm! ja !juod "j#go.

    Bcrrjrs t`g g*cfg!cjmjcehm trhosctcjo

    +BCs coerghscomy aheg njt` coagetcjo%

    hssjechtgf ehoegrs, hof hmm jt`gr ehoegrs-

    V`g hoegr Vrhosctcjo+junmg nurfgo %jr `ghmt` systg"s

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    )rghst ehoegr cs,

    V`g "jst ej""jo ehoegr j% 8j"go (mjnhmmy hoft`g sgejof "jst ej""jo ehoegr jvgrhmm

    >/4 "cmmcjo og8 ehsgs 0yghr - >>3 j% hmm ehoegrs

    7/< "cmmcjo 8j"go mcvg nrghst ehoegr &fch(ojsgf'

    955=222 fght`s pgr yghr

    Cs h"jo( t`g tjp 9 ehusgs j% fght` co "cffmg

    coej"g ejuotrcgs

    > co < 8j"go co t`g $U 8cmm `hvg ) co t`gcr mcvgs

    $jureg &stc#htgs nhsgf jo fhth arj# 'mjnjeho (;)(

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    Co 1BCs h vgry mhr(g 3 j% )rghst hoegr

    ehsgs hof fght`s hrg co 8j"go ?99

    @cd` CoejbgMjw coejbg

    87-53

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    !

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    Mhtco Hbgrceh

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    hoegr cs h fcsghsg ja njt` rce` hof *jjr.

    ygt ct cs coerghscomy t`g *jjr )`j s/aagr/ Gxpjsurg tj rcsi %hetjrs

    5/ #rgvgothnmg ehoegrs &co%getcjo'

    6/ Vrghthnmg ehoegr fght` hof fcshncmcty7/ Utc("h hof fcserc"cohtcjo

    9/ Hvjcfhnmg phco hof su%%grco(

    V`g hoegr +cvcfg*

    Ho Gqucty C"pgrhtcvg

    Aheg

    ts

  • 7/21/2019 Transforming Health Systems to Meet the challenge of Breast Cancer and Chronic Care: A Diagonal Approach

    15/45$jureg *ohum+ ,rrgjmh+ Bgofg-. gstc#htgs nhsgf jo C,E+ 'mjnjeho+ (;);.

    (/rvcv

    hm

    cog;/hmcty

    h*

    V`g :ppjrtuocty tj Uurvcvg

    K Bjrthmcty0Coecfgoeg K cs=

    nut s`jumf ojt ng= fg%cogf ny coej"g/

    Hm"jst 23 j% hohfcho e`cmf`jjf mguig"ch phtcgots survcvg,Co t`g pjjrgst ejuotrcgs jomy >23 survcvg/

    Mjw

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    V`g "jst coscfcjus coNustceg*

    t`g phco fcvcfg

    bcm b$

    Bgcej!5

    "7;; bd

    %% bcm b$

    Ujureg< Gstcbhecjogs prjpchs Iohum A.B. Hrrgjmh @, gt.hm.,

    nhshfj go fhtjs fg< Vrght t`g phco hof CON

    ! ttp23* "cm "(

    $U0hohf* 677 "cm "(

    Mhtco Hbgrceh

    H&rceh

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    &jr#ho! 86";;; bd

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    `hmmgo(g hof fcsprjvg t`g

    "yt`s hnjut ehoegr

    B>/ $oogegsshry EGGUUH

    B5/ $oh%%jrfhnmg HAA:+H)1G

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    V`g ejsts tj emjsg t`g ehoegr fcvcfg hrg

    hof "hy ng mgss t`ho "hoy %ghr*

    Hmm n/t 5 ja > +BC *rcjrcty ehoegr

    e`g!j hof `jr!johm hgots hrg jaa%*htgot

    hco !gfcehtcjo cs e`gh*rcegs frj*< g*6 hof Q vheecogs

    Fgmcvgry & acohoeco coojvhtcjos ehohrghtg */re`hsco hof sthnhmcsg

    *rje/rg!got

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    V`g ejsts j% cohetcjo hrg `u(g*

    Covgst#$hetcjoVjnheej cs h `u(g gejoj"ce rcsi* 6/3 mj8gr D+#

    Vjthm gejoj"ce ejst j% ehoegr= 52>2* 5;73 (mjnhm D+#

    rgvgotcjo hof trght!got jaagr

    *jtgotchm )jrmf shvcos ja

    7 1( 854%#4 ncmmcjo

    805%80> ja ehoegr fght`s hrg 3hvjcfhnmg-#%5-9 !cmmcjo fght`s,

    ja )`ce` =42 hrg co +CBs

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    `h"pcjos

    K t`g gejoj"ces j% `jpg*

    Ejngm

    H"hrtyhUgo=hoegr

    survcvjr

    fch(ojsgfhof trghtgf

    co Cofch 9

    yghrs h(j

    +rg8 D/ Ahust#rgscfgot j% @hrvhrf $

    59. yghr ) survcvjr

    @hrvhrf= )rghst hoegr co +gvgmjpco( juotrcgs=>2 2

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    `hmmgo(g hof fcsprjvg t`g

    "yt`s hnjut ehoegr

    B>/ $oogegsshry EGGUUH

    B5/ $oh%%jrfhnmg HAA:+H)1G

    B6/ Cohpprjprchtg H##:#CHVG

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    Lj"go hof "jt`grs co 1BCs

    %heg "hoy rcsis t`rju(` t`g mc%g eyemg

    Tjbgo 87%7&, hoouhm fght`s

    +chngtgs

    >>2=222;

    >6=222

    )rghst

    ehoegr

    >92=222;>9=222

    $jureg &stc#htgs nhsgf jo fhth arj# /8 'mjnhm ghmt` 8nsgrvhtjr!+ (;;> hof Burrh! gt hm Mhoegt (;)).

    grvcehm

    ehoegr

    >29=222;>6>=222

    Bjrthmcty

    co

    e`cmfncrt`

    5>=222

    ; 693co 62

    yghrs

    - 646=222 K 79=222

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    Hppmcgs h fch(johmhpprjhe` tj hvjcf

    t`g %hmsg fcmg""hs

    ngt8ggo fcsghsg

    scmjs t`ht

    ejotcoug tj pmh(ug

    (mjnhm `ghmt`

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    V`g +ch(johm Hpprjhe` tj

    @ghmt` Uystg" Utrgo(t`goco(

    ?ht`gr t`ho aje/sco jo gct`gr fcsghsg%s*gecace vgrtcehm jr`jrc:jothm%systg!ce *rjrh!s, `hrogss syogrcgs t`ht

    *rjvcfg j**jrt/octcgs tj themg fcsghsg%s*gecace *rcjrctcgs

    )`cmg hffrgssco systg!ce h*s hof j*tc!c:g hvhcmhnmg

    rgsj/regs

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    +gmcvgry %hcmurg

    -jjr

    ^ce.

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    uhocth* Hfvhoegf

    "gthsthtce nrghst ehoegr ; hsgrcgs j% "cssgf jppjrtuoctcgs ht

    t`g prc"hry mgvgm j% ehrg

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    8/"; 8/%; 8/#; 8/4; 8/0; 8//; >;;;

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    "jrthmcty= $UH= >72K5222/

    U`umbho, Tcmmgtt, .ohum gt hm+ Nhsgf jo t`g Ejoogetceut U// fhth nhsg

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    +c mc c + mc V c c c

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    +ch(johmcOco( +gmcvgry* Vrhcoco( prc"hryehrg prj"jtgrs= oursgs hof fjetjrs coghrmy fgtgetcjo j% nrghst ehoegr

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    0

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    cs (ejrg

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  • 7/21/2019 Transforming Health Systems to Meet the challenge of Breast Cancer and Chronic Care: A Diagonal Approach

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    @DGC 1 t c c Dm n m H t # c

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    @DGC;1hoegt j""csscjo jo Dmjnhm Heegss tj #hco

    jotrjm hof #hmmchtcvg hrg

    -Dmjnhm @ghmt`

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    .#hmmchtcvg ehrg

    spgechmcsts

    Djhm* Hmmgvchtg Hvjcfhnmg

    #hco J Uu%%grco(

    1hstco( survcvjrs`cp e`hmmgo(gs

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    8- Aghr0/oegrthcoty s/rrj/ofco agrtcmcty>- 6jfy c!hg *greg*tcjo e`hmmgogs

    5- $!*mjy!got fcserc!cohtcjo hof cts c!*het

    #- +jss ja sjechm ogt)jrs'- 1o!gt *rc!hry hof *sye` ehrg oggfs

    1hstco( survcvjrs`cp e`hmmgo(gs

    %jr yjuo( 8j"go*

    b/'j)bgot #csercbcohtcjo=2h /grsjo wct` ehoegr" oj jog whots tj gb/'j) t`gb 4geh+sg wg hrg oj 'jodgr +sg,+':

    =C 'cg tj s/gh t`g tr+t` w`go C dj tj hs ,jr h j C tg'' t`gb" KC `h# ehoegr ho# C `hg tj dj

    tj 2h//jcotbgots" t`g) tg'' bg" Kwg #jot h''jw hsgoegs" K `hos" sgg )j+ 'htgr:

    4j#) cbhdg" /s)e`jsjech' ogg#s N e`hodg w tcbg

    =`g) h'wh)s tg'' bg" K#rgss +/" bhg )j+rsg', +/" #j t`cs" ho# C sh)" K,jr w`htE *jr w`ht ojwE C`hg gejbg #g/rgssg# ojt #g/rgsscjo" hs C tj'# )j+" h 'he j, cotgrgst:

    2t`g ,crst )ghrs #c# ojt h,,get bg2 C #c# ojt ehrg2 ojw ct cs h,,getcod bg *jr h )ghr" C `hg ggosggcod b)sg', ho# ojt heeg/tcod b)sg'," ct cs gr) `hr# ,jr bg tj heeg/t b)sg', hs h C ojw hb:

    Gvcfgoeg nhsgf pjmcey*

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    Gvcfgoeg;nhsgf pjmcey*

    Acofco(s hof rgej""gofhtcjos

    (/rvcvjrs`c* ehrg cs hnsgot co +BCs, ygt ejotgKt%s*gecace Co +BCs s/rvcvjrs`c* ehrg )cmm ngej!g coerghsco oggfgf

    hs g*cfg!cjmjcehm trhosctcjo *rjeggfs hof rgajr!

    coerghsgs `ghmt` ehrg ejvgrhg hof heegss-

    (/rvcvjrs`c* ehrg !/st ng cotgrhtgf cotj 1 hof ghe`

    `ghmt` systg! a/oetcjo Gstg)hrfs`c*, acohoeco, fgmcvgry, eh*hecty n/cmfco@

    $f/ehtg *jmcey%!hgrs hnj/t mjo%tgr! ehrg hof;/hmcty%ja%mcag css/gs coem/fco mghm *rjtgetcjo

    hphecty nucmfco( %jr p`yscechos= oursgs=

    jt`gr `ghmt` ehrg prjvcfgrs hof prj"jtgrs ht

    t`g prc"hry mgvgm

    # mc c t c c mt >2 222 c

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    #rgmc"cohry trhcoco( rgsumts* >2=222 prc"hry

    ehrg p`yscechos hof oursgs= 52>7

    `)scechosG6"0>

    +rsgsG>">65

    -h

    'c,cehecAo

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    @gh't` ()stgb*+oetcjos

    (thdg j, `rjoce Fcsghsg Mc,g )e'g .ejb/jogots

    rcbhr)rggotcjo

    (gejo#hr)/rggotcjo.

    ghr')#gtgetcjo

    Fchdojscs rghtbgot(+rcjrs`c/.g`hc'cthtcjo

    h''chtcjo.o#-j,-'c,g ehrg

    (tgwhr#s`c/

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    ejrg `ghmt` systg" %uoetcjo

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    )g ho

    jptc"cst

    jptc"hmcst

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    Agmcech Bhrcg Iohum

    hrvhrf Dmjnhm Gqucty Coctchtcvg

    hrvhrf Bgfcehm Ue`jjm

    mjnhm Vhsi Ajreg jo Gxphofgf Heegss tj hoegr hrg hof jotrjm

    gxceho @ghmt` Ajuofhtcjo

    !"htgmj h #ge`j

    rhos%jr"co( @ghmt` Uystg"s tj Bggt t`g`hmmgo(g j% )rghst hoegr hof `rjoce hrg*+ch(johm Hpprjhe`

    ghst Ehoegr co t`g Hrhn TjrmfBhre` >5, >;879 Hbbho, Ljrfho