Implementation of Suspected Cancer Initiative to Improve Cancer Diagnosis Timeliness in a Large Public Hospital System.

Abstract

The purpose of this quality improvement project was to evaluate the impact of the Suspected Cancer Initiative (SCI)-an electronic medical record (EMR)-based suspected cancer flag-on diagnostic timeliness across a large public hospital system. We aimed to analyze the program's impact on reducing time to diagnostic workup and to explore demographic factors associated with diagnosis timeliness. NYC Health + Hospitals is the municipal safety net health system in New York City. Before the SCI, there was no process for tracking and triaging patients with suspected cancer. We implemented the SCI across four components: (1) an EMR referral flag within the physician workflow, (2) referral guidelines embedded into the EMR, (3) a dashboard to track metrics, and (4) a steering committee with specialty leaders. The primary outcomes measured were time from referral to (1) specialty appointment scheduling, (2) specialty appointment, (3) biopsy, and (4) diagnosis. The manuscript analyzes data from 6,087 patients referred through the SCI. In all, 61.1% of patients were female and 41.5% were age ≥65 years. In total, 40.3% were Hispanic, 36.8% were African American, and 57.1% spoke English. Compared with the first month of implementation, we saw a 56.6% improvement (10.9 days) in time from referral to specialty appointment scheduling, a 57.2% improvement (31.2 days) in time from referral to specialty appointment, a 69.6% improvement (80.9 days) in time from referral to biopsy, and a 68.2% improvement (63 days) in time from referral to diagnosis. Prioritizing patients with suspected cancer using a multipronged approach improved the timeliness of care. An SCI was implemented using existing resources and served as a cost-effective way to improve care for high-risk patients.