Timely access and quality of care in colorectal cancer: a population-based cohort study using administrative data

BMC Research Notes

Eva Grunfeld⁵  Yarrow McConnell³  Jingyu Bu²  Cynthia Kendell¹  Robin Urquhart¹  Geoffrey Porter⁴ 

[1] Cancer Outcomes Research Program, Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada;New Brunswick Cancer Network, Government of New Brunswick, Fredericton, New Brunswick, Canada;Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada;Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada;Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada

关键词: Evaluation;    Access;    Healthcare quality;    Quality indicators;    Colorectal neoplasms;   

Others  :  1141745
DOI  :  10.1186/1756-0500-6-355

 received in 2012-12-04, accepted in 2013-08-28,  发布年份 2013

【 摘 要 】

Background

While efforts to improve cancer outcomes have typically focused on improving quality of care, recently, a growing emphasis has been placed on timely access to quality cancer care. This retrospective cohort study examines, at a population level, the relationship between quality and timeliness of colorectal cancer (CRC) care in a single Canadian province (Nova Scotia). Through the provincial cancer registry, we identified all residents diagnosed with invasive CRC between 2001 and 2005 that underwent a non-emergent resection. Using anonymized administrative databases that are individually linked at the patient level, we obtained clinicodemographic, diagnostic, and treatment event data. Selected charts were reviewed to ensure completeness of chemotherapy data.

Performance on six quality indicators and the percentage of patients achieving wait-time benchmarks for diagnosis, surgery, and adjuvant therapy were calculated. The relationship between quality indicators and wait-time benchmarks was examined using logistic regression.

Results

Where an association was identified, patients who received ‘higher quality care’ had longer wait times. Individuals who received a complete preoperative colonoscopy were less likely to meet benchmarks for time from presentation to diagnosis and from diagnosis to surgery. Those who received an appropriate radiation oncology consultation were less likely to meet benchmarks for time from diagnosis to surgery and from surgery to adjuvant therapy.

Conclusions

As governments and other organizations move forward with strategies to reduce wait times, they must also focus on how to define and monitor quality care, and consider the relationship between these two dimensions of health care. Similarly, when developing quality improvement initiatives, the impact on resource utilization and potential to create longer waits for care must be considered.

【 授权许可】

   
2013 Porter et al.; licensee BioMed Central Ltd.

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