Effect of a cancer tracking system on timeliness of liver cancer care at a Veteran's Hospital.

Abstract

406 Background: Hepatocellular carcinoma (HCC) requires complex care coordination with opportunities for care delays and untimely follow-up of abnormal liver imaging results. An electronic medical record-linked abnormal imaging identification and tracking system was implemented at a Veterans Affairs Hospital. The system reviews all liver radiology reports, generates a queue of abnormal cases for care coordinator review, and provides a tracking feature to monitor each patient’s care. Methods: This is a pre-/post-intervention study to evaluate whether implementation of this tracking system reduced (1) time between HCC diagnosis and treatment and (2) time from first suspicious image to first specialty care appointment, diagnosis, and treatment. Patients diagnosed with HCC in the 37-months before tracking system implementation (pre-intervention) were compared with patients diagnosed with HCC in the 71-months (less an 11-month grace period) after tracking system implementation (post-intervention). Linear regression was used to calculate mean change in relevant intervals of care pre- and post-intervention adjusted for patient age, race, ethnicity, BCLC stage at diagnosis, and indication for first suspicious image. Results: There were 60 patients in the pre-intervention period and 127 in the post-intervention period. The post-intervention group had a greater proportion of HCC diagnosed at earlier BCLC stages (p<0.03). Compared to the pre-intervention cohort, the post-intervention cohort had an adjusted mean reduction of 36 days from diagnosis to treatment (p=0.007), 51 days from suspicious imaging to diagnosis (p=0.21), and 87 days from suspicious imaging to treatment (p=0.05). Stratified by indication for first suspicious imaging, patients whose imaging was performed for HCC screening had the greatest decreases in time from diagnosis to treatment (63 days, p=0.02) and from first suspicious image to treatment (179 days, p=0.03). Conclusions: Our tracking system improved timeliness of HCC diagnosis and treatment. We anticipate it may improve HCC care coordination and delivery, including when added to HCC screening protocols.[Table: see text]