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AP-010

LBCL, 75 plus, rural, Medicare, 76 to 150 miles

Allo-HCT · Phase 2, Candidacy Evaluation · 24 days in stage · 11 barriers, 3 blocking

Watch24 days in work-up to candidacy decision, approaching the 30-day target

Delivery

Navigation plan

12 tasks are on this plan, 3 still open. The engine suggests 35 in total from this patient's barriers, so 23 have no owner yet. Statuses persist here.

Completion criteria, in order

Three things that each have to be true before treatment can happen. Work here unblocks everything downstream, which is why it sits above the rest of the plan rather than inside it.

Step 1 · Reach a center

1 flag

referred and accepted for evaluation

In the way: Late referral / progression before treatment

  • Refer early — at first relapse / by 2nd line; do not wait

    Referring / community oncReach: Treatment center27 days overdue
    Done

Step 2 · Be accepted as a candidate

2 flags

the center recommends treatment

In the way: Eligibility / patient-selection hurdles · Caregiver & psychosocial clearance

  • Push for fitness-based (not age-based) selection using real-world evidence

    Treatment-center teamReach: Treatment center27 days overdue
    Done

  • Request a fast-track, shared referrer–center eligibility assessment

    Treatment-center teamReach: Treatment center27 days overdue
    Done

  • Confirm the center’s caregiver requirement and any flexibility

    Nurse navigatorReach: Treatment centerDue in 21 days
    Not started

Step 3 · Secure approval to proceed

Clear

authorization and coverage in place

Nothing on the plan clears this criterion yet.

Feasibility and support

Work that makes treatment possible and bearable rather than permitted. Regroup it along whichever axis matches how you are working today.

Refer & establish candidacy

6 tasks

  • Set up a single point of contact / intake coordinator with the center

    Nurse navigatorReach: Treatment center27 days overdue
    Done

  • Use a standardized identification trigger (If they RECUR, refer)

    Referring / community oncReach: Internal — no outside contact27 days overdue
    Done

  • Fast-track the pre-apheresis work-up to shorten decision-to-vein time

    Treatment-center teamReach: Treatment center27 days overdue
    Done

  • Arrange prehab / optimization to improve pre-treatment fitness

    Nurse navigatorReach: Treatment center27 days overdue
    Done

  • Ensure disability accommodations so assessment is equitable

    Nurse navigatorReach: Treatment center27 days overdue
    Done

  • Check for a nearer community / outpatient CAR-T program

    Nurse navigatorReach: Treatment center27 days overdue
    Done

Build the access plan

1 task

  • Start caregiver planning now; explore paid-caregiver and respite options

    Social workReach: Caregiver / familyDue in 14 days
    Not started

Confirm coverage & authorization

1 task

  • Have the navigator shoulder the administrative burden (auth, appeals, benefits)

    Nurse navigatorReach: Internal — no outside contactDue in 21 days
    Not started

Handoffs

An explicit transfer of responsibility, tracked separately from tasks because the failure mode is different: nobody is late and nobody is idle, the work simply has no owner until somebody acknowledges it.

Referring / community oncNurse navigator

Referral received and accepted for work-up.

Acknowledged

Every task traces back to a barrier that actually fired for this patient.

  • The plan is not separate authoring. It is the assessment projected forward.
  • That is what makes it maintainable at all.