Diagnostic intervals before and after implementation of cancer patient pathways - a GP survey and registry based comparison of three cohorts of cancer patients.

Henry Jensen,Jens Overgaard,Peter Vedsted,Morten Fenger-Grøn,Marie Louise Tørring,Frede Olesen

doi:10.1186/s12885-015-1317-7

Henry Jensen, Jens Overgaard + Show 4 more

Open Access

https://doi.org/10.1186/s12885-015-1317-7

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Journal: BMC cancer	Publication Date: Apr 23, 2015
Citations: 89	License type: CC BY 4.0

Affiliation: Aarhus University Hospital, Aarhus University

Abstract

BackgroundFrom 2008, Danish general practitioners could refer patients suspected of having cancer to standardised cancer patient pathways (CPPs).We aimed to compare the length of the diagnostic interval in 2010 with the length of the diagnostic interval before (2004/05) and during (2007/08) the implementation of CPPs in Denmark for all incident cancer patients who attended general practice prior to the cancer diagnosis.MethodsGeneral practitioner questionnaires and register data on 12,558 patients were used to compare adjusted diagnostic interval across time by quantile regression.ResultsThe median diagnostic interval was 14 (95% CI: 11;16) days shorter during and 17 (95% CI: 15;19) days shorter after the implementation of CPPs than before. The diagnostic interval was 15 (95% CI: 12;17) days shorter for patients referred to a CPP in 2010 than during the implementation, whereas patients not referred to a CPP in 2010 had a 4 (95% CI: 1;7) days longer median diagnostic interval; the pattern was similar, but larger at the 75th and 90th percentiles.ConclusionThe diagnostic interval was significantly lower after CPP implementation. Yet, patients not referred to a CPP in 2010 tended to have a longer diagnostic interval compared to during the implementation. CPPs may thus only seem to expedite the diagnostic process for some cancer patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1317-7) contains supplementary material, which is available to authorized users.

Highlights

From 2008, Danish general practitioners could refer patients suspected of having cancer to standardised cancer patient pathways (CPPs)
The overall result remained the same when we adjusted for differences between populations; the median diagnostic interval (DI) was 14 days shorter during the transition stage than before CPP implementation and 17 days shorter after CPP implementation (Table 3)
We found that the median length of the DI in Denmark was shorter after the CPP implementation than before the CPP implementation; the largest difference was found between the period before the CPPs (2004/05) and during the implementation phase in 2007/08

Summary

Introduction

From 2008, Danish general practitioners could refer patients suspected of having cancer to standardised cancer patient pathways (CPPs). We aimed to compare the length of the diagnostic interval in 2010 with the length of the diagnostic interval before (2004/05) and during (2007/08) the implementation of CPPs in Denmark for all incident cancer patients who attended general practice prior to the cancer diagnosis. Standardised cancer patient pathways (CPPs) have been introduced in some countries [1,2,3,4,5,6,7,8]. After years of increasing waiting times for cancer patients in Denmark, the Danish government and the Danish regions (i.e. hospital owners) declared in 2007 that cancer should be diagnosed and treated without delay [9]. The DI is important as it measures the timeliness of the health-care system as a whole across sector boundaries

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