Internal medicine resident continuity clinic and academic cancer center: Implementation of a collaborative model for primary care.

Abstract

267 Background: Despite complex medical needs, many cancer patients lack a primary care physician. Barriers to access can delay prevention and increase reliance on emergency services. In 2024, new patients at Stanford faculty primary care clinics waited an average of 45 business days between referral and appointment. To improve access, we established a fast-track primary care referral pathway at the Stanford Internal Medicine Resident (SIME) continuity clinic in collaboration with the Stanford Cancer Center. Methods: A “Fast-Track Primary Care” referral was created in the electronic health record and introduced to the Breast Oncology Clinic, then expanded to the entire Cancer Center. Patients on clinical trials, nearing end of life, or receiving hospice care were excluded. The model was assessed by time from referral to new patient visit (NPV) and management of hypertension, hyperlipidemia, and type 2 diabetes (T2D). Patients were referred from November 2024 to August 2025. Results: Of 114 referrals received, median time from referral to NPV was 9 days, with a 50% conversion rate. Demographics of seen versus not-seen patients were comparable, but seen patients had more chronic conditions, including T2D (23% vs. 0%), hypertension (32% vs. 0%), and hyperlipidemia (35% vs. 5%). At their new patient visit, 54% of those with diabetes had uncontrolled A1c (>7%), 72% of those with hypertension had uncontrolled blood pressure (>130/80 mmHg), and 55% of those with hyperlipidemia had elevated LDL (>100 mg/dl), highlighting an unmet need for better comorbidity management. In patients that received treatment, 31% had improved A1c (median reduction of 0.9%), 61% had improved blood pressure, and 35% had improved LDL (median reduction of 43 mg/dl). Cancer screening was completed in 23 patients and 20 received 1 or more vaccines. Conclusions: This study demonstrates the feasibility of a collaborative care model between a resident primary care clinic and a cancer center population with complex care needs and chronic conditions. The program improved referral-to-visit turnaround time compared to faculty primary care clinic referrals, and patients seen experienced improvements in A1c, blood pressure, and LDL. Baseline comorbidity control and outcomes, seen vs. not seen. Comorbidity Not Seen % (n/N) Seen % (n/N) Quality Metric Outcome Diabetes 0 (0/57) 23 (13/57) Median ΔA1c (range) -0.9 (-6.2 – 0.8) A1c >7 0 (0/13) 54 (7/13) A1c improved? % (n/N) 31 (4/13) Hypertension 0 (0/57) 32 (18/57) Initial BP >130/80 0 (0/29) 72 (13/18) Blood pressure improved? % (n/N) 61 (11/18) Hyperlipidemia 5 (3/57) 35 (20/57) Median ΔLDL (range) -43 (-120 – 48) Initial LDL >100 0 (0/21) 55 (11/20) LDL improved? % (n/N) 35 (7/20)