Innovating patient-facing care pathways in breast cancer using the 4R model, 4R = Right Information / Care / Patient / Time

Northwestern University Feinberg School of Medicine
ASCO’s “Criteria for High-Quality Clinical Pathways in Oncology” calls for development of multi-modality patient focused pathways.  However, clinical pathways are typically created for provider use. The innovative 4R model, developed by the Center for Business Models in Healthcare and Northwestern University, offers an approach to create cancer care pathways which empower patients in conjunction with their care team.  4R model is Right information and Right care for the Right patient at the Right time.  This project will implement the 4R model for a target population of breast cancer patients and care teams at two major safety net institutions.  4R will be implemented at each site using Comprehensive Dynamic Trial (CDT) methods, an adaptation of Edward Deming’s PDSA (Plan-Do-Study-Act).  Metrics will be collected prior to the implementation (historical) and after the implementation to assess the impact of the project.
The 4R model incorporates the recommendations for patient-centric care pathway plans from the Institute of Medicine, Medicare’s Oncology Care Model (OCM), and National Comprehensive Cancer Network’s guidelines including: multi-modality planning from diagnosis to survivorship or hospice, specifying clinical team and their responsibilities; and inclusion of definitive and supportive cancer care in the plan. Use of 4R Sequences engages the patient and family in a personalized, systematic and effective way.  Additionally, the 4R model addresses complexities of cancer care, such as challenges coordinating timing and sequencing of interdependent guideline indicated care events (Taplin et al, JOP 2015). These challenges lead to care delays, breakdowns, and sub-optimal changes to the care trajectory.  These challenges are especially pronounced for vulnerable populations.
Overall Goal: To help breast cancer patients, their families/caregivers, and their care team manage guideline indicated care through use of 4R patient care sequences/pathways.
Approval Date:
November 2017
Amount Awarded:
Start Date:
End Date:
In Progress
2017 Clinical Pathways in Breast Cancer