John Libbey Eurotext

Bulletin du Cancer

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Organisational diagnosis of a home care-coordinating unit in oncology: which choices for the comprehensive cancer center of Lyon? Volume 93, issue 10, Octobre 2006

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Authors
Coordination des soins à domicile (CSAD), Centre Léon-Bérard, 28, rue Laennec, 69373 Lyon Cedex 8, Ifross-Graphos, UMR-CNRS 5823, laboratoire de recherche sur les organisations sanitaires et sociales et leurs réseaux, Lyon, Cabinet Latitude Santé – Audit, Conseil et stratégie en santé, Crémieu, Direction générale, Centre Léon-Bérard, Lyon
  • Key words: cancer, home care, home-hospital network, hospital at home, coordinating care, strategic diagnosis
  • DOI : 10.1684/bdc.2006.0035
  • Page(s) : 1039-46
  • Published in: 2006

Lyon comprehensive cancer center developed a home care-coordinating unit (HCCU) allowing a wide range of cancer care at home. We present the results of an organisational and strategical analysis of the unit, in relation with internal and external contexts. We describe the functioning of the unit, modelled from the daily follow-up of professionnels. Patient discharge is initiated by the oncologist at the inpatient clinic, at the day-hospital or at outpatient visit. After consent of the patient and relatives, the HCCU (nurses and medical oncologists) evaluates patient’s needs, organises hospital discharge (contacts with community nurses and general practitioner, supply of medical appliances and drugs), and provides follow-up and counselling to patient and caregivers. The HCCU works in a challenging environment, with both partners and competitors. Within the hospital, it collaborates with all other units. Outside the hospital, partners are, besides patients themselves; general practitioners and community nurses home care agencies and network services, private medical appliance providers, and public health authorities. The unit might evolve towards formal home hospitalisation or community-hospital network. Collaboration of both structure closely associated with hospital could allow to provide continuous and graduated care by the same caregivers even if administrative structures change.