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A Distributed Cancer Care Model with a Technology-Driven Hub-and-Spoke and Further Spoke Hierarchy: Findings from a Pilot Implementation Programme in Kerala, India

A Distributed Cancer Care Model with a Technology-Driven Hub-and-Spoke and Further Spoke Hierarchy: Findings from a Pilot Implementation Programme in Kerala, India 

Venkataramanan Ramachandran, Akash Pradhan, Abhishek Kumar, Bharat Kumar Sarvepalli, Sripriya Rao, Kunal Oswal, Raja Sekhar Kommu, Manish Sharma, Sarika Pathak, Ramdas Kunnambath, Moni Abraham Kuriakose, Sankarnarayana Rengaswamy, Mohannad Alajlani, Theodoros N ArvanitisĀ 

Abstract

Background: The technology enabled distributed model in Kerala is based on an innovative partnership model between Karkinos Healthcare and private health centers. The model is designed to address the barriers to cancer screening by generating demand and by bringing together the private health centers and service providers at variousĀ  levels to create a network for continued care. This paper describes the implementation process and presents some preliminary findings. Methods: The model follows the hub-and-spoke and further spoke framework. In the pilot phases,Ā  from July 2021 to December 2021, five private health centers (partners) collaborated with Karkinos Healthcare acrossĀ  two districts in Kerala. Screening camps were organized across the districts at the community level where the targetĀ  groups were administered a risk assessment questionnaire followed by screening tests at the spoke hospitals basedĀ  on a defined clinical protocol. The screened positive patients were examined further for confirmatory diagnosis at theĀ  spoke centers. Patients requiring chemotherapy or minor surgeries were treated at the spokes. For radiation therapy andĀ  complex surgeries the patients were referred to the hubs. Results: A total of 2,459 individuals were screened for cancerĀ  at the spokes and 299 were screened positive. Capacity was built at the spokes for cancer surgery and chemotherapy.Ā  A total of 189 chemotherapy sessions and 17 surgeries were performed at the spokes for cancer patients. 70 patientsĀ  were referred to the hub. Conclusion: Initial results demonstrate the ability of the technology Distributed Cancer CareĀ  Network (DCCN) system to successfully screen and detect cancer and to converge the actions of various private healthĀ  facilities towards providing a continuum of cancer care. The lessons learnt from this study will be useful for replicatingĀ  the process in other States.Ā Ā 

Keywords: Cancer- early detection- screening- technology- India- Kerala- hub and spoke model-

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