Development of a time to treatment metric across an NCI designated academic health system.

Abstract

307 Background: Time to treatment (TTT) is an important quality metric as shorter times improve patient satisfaction and retention, overall survival, as well as reduce distress. Multiple factors can lengthen TTT including provider availability, biopsy, pathology review, assembly of medical records, multidisciplinary care coordination, staging studies, and patient preference. No national benchmarks exist for TTT, however one large health system noted baseline TTT (indexed on diagnosis date) of 29d for internally diagnosed and 41d for externally diagnosed patients ( Khorana & Bolwell, NEJM Catalyst, 2019 ). Limited guidance exists on how best to measure TTT for cancer patients across an institution. Methods: We developed a consistent TTT metric across Yale’s Smilow Cancer Hospital, comprised of an academic hub and community practices, using data obtained from Flatiron Health’s EHR-derived de-identified database, with disease team assigned for each provider. Qualifying patients had a new patient visit between Jan - Dec 2018, and scheduled treatments from Jan 2018 - Mar 2019. We defined TTT as calendar days from the first qualifying visit to the sooner of either an IV antineoplastic administration or interventional surgery. Results: The population sample included 1,090 patients seen by five disease teams. 558 (51%) patients had a qualifying intervention. The overall median TTT was 26d (IQR14 - 44). The median TTT for IV antineoplastic administration was 24d (IQR 14 - 43). The median TTT for interventional surgery was 27d (IQR 15 - 45). The median TTT by disease team: Breast 24d (IQR 14 - 38), GI 24d (IQR13 - 36), Head & Neck 27d (IQR 15 - 40), Hematology 35d (IQR 11 - 76), and Thoracic 28d (IQR 16 - 51). Conclusions: Evaluating TTT across an institution can help identify opportunities for practice improvements. We hypothesize that recurring delivery of this metric will enable assessment and benchmarking of quality improvement interventions. Future work will focus on improving this measure by incorporating additional cancer treatments (e.g. radiation therapy), and development of interventions to shorten TTT at our center.