Publication Date
7-20-2024
Journal
Journal of Clinical Oncology
DOI
10.1200/JCO.23.01523
PMID
38718321
PMCID
PMC11268555
PubMedCentral® Posted Date
5-8-2024
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Humans, Male, Female, Aged, Middle Aged, Electronic Health Records, Lung Neoplasms, Emergency Service, Hospital, United States, Colorectal Neoplasms, Quality Indicators, Health Care, United States Department of Veterans Affairs, Neoplasms
Abstract
PURPOSE: Missed and delayed cancer diagnoses are common, harmful, and often preventable. Automated measures of quality of cancer diagnosis are lacking but could identify gaps and guide interventions. We developed and implemented a digital quality measure (dQM) of cancer emergency presentation (EP) using electronic health record databases of two health systems and characterized the measure's association with missed opportunities for diagnosis (MODs) and mortality.
METHODS: On the basis of literature and expert input, we defined EP as a new cancer diagnosis within 30 days after emergency department or inpatient visit. We identified EPs for lung cancer and colorectal cancer (CRC) in the Department of Veterans Affairs (VA) and Geisinger from 2016 to 2020. We validated measure accuracy and identified preceding MODs through standardized chart review of 100 records per cancer per health system. Using VA's longitudinal encounter and mortality data, we applied logistic regression to assess EP's association with 1-year mortality, adjusting for cancer stage and demographics.
RESULTS: Among 38,565 and 2,914 patients with lung cancer and 14,674 and 1,649 patients with CRCs at VA and Geisinger, respectively, our dQM identified EPs in 20.9% and 9.4% of lung cancers, and 22.4% and 7.5% of CRCs. Chart reviews revealed high positive predictive values for EPs across sites and cancer types (72%-90%), and a substantial percent represented MODs (48.8%-84.9%). EP was associated with significantly higher odds of 1-year mortality for lung cancer and CRC (adjusted odds ratio, 1.78 and 1.83, respectively, 95% CI, 1.63 to 1.86 and 1.61 to 2.07).
CONCLUSION: A dQM for cancer EP was strongly associated with both mortality and MODs. The findings suggest a promising automated approach to measuring quality of cancer diagnosis in US health systems.
Included in
Emergency Medicine Commons, Internal Medicine Commons, Medical Sciences Commons, Quality Improvement Commons