Operation Innovation: A New Level of Care and Service for Breast Cancer Screening, Detection, and Treatment

Abstract

Nationally, a woman's lifetime risk of being diagnosed with breast cancer is 13.2%. Breast cancer is the second leading cause of cancer death in women.1 Research has shown that early and prompt breast cancer screening, detection, diagnosis, and treatment can save lives.2–4 Operation Innovation was conceived and implemented at Kaiser Permanente (KP) by a multidisciplinary group of physicians, health care professionals, bargaining unit staff, and administrators from the KP Riverside Service Area to improve breast cancer screening, detection, and treatment services for members and patients. … early and prompt breast cancer screening, detection, diagnosis, and treatment can save lives.2–4 Operation Innovation includes two distinct-yet-related components: mammography outreach and timely diagnosis of breast cancer. Interventions to promote mammography screening focused on reaching internal performance goals as well as external benchmarks, including the clinical strategic goals set by the KP Southern California Region (KPSC) as well as the Health Plan Employer Data and Information Set (HEDIS) measurements set by the National Committee for Quality Assurance (NCQA). To support and complement activities encouraging mammography screening, additional steps were taken to reduce the number of days from “time of suspicion” to “time of diagnosis.” Targeted “days wait” performance goals are set annually by the Southern California Permanente Medical Group (SCPMG) Regional Chiefs of Radiology/Diagnostic Imaging and General Surgery. A distinguishing aspect of the project is its comprehensive and collaborative approach to delivering breast cancer care and services for our members and patients. In November–December 2003, the KP Riverside Service Area's baseline screening mammography rate for the target group was 79.1% while the leading medical center in the KPSC had a rate of 84.4%. In response, Riverside assembled a multidisciplinary team of KP health care professionals to develop an outreach intervention plan. The team reviewed literature and best practices, assessing their potential to increase initial and ongoing mammography use, before selecting three specific outreach methods: “Mammography Call Outreach,” “Focused Mammography Outreach,” and “Mobile Mammography Outreach.” As of April 2005, Riverside's breast cancer screening rate had reached 89.8%, the highest in the KPSC, outpacing the other service areas in the Region by a mean of about 8%. Riverside's performance also exceeds national and external benchmarks, such as HEDIS measurements. A KPSC report distributed in July 2003 provided preliminary baseline data on the time elapsed from initial suspicion of breast cancer to diagnosis. KP Riverside Service Area statistics showed that only 32% of the cases examined were diagnosed within the recommended target of 14 days from the initial suspicious findings. The median number of days from suspicion to diagnosis was 19 (range 2–52 days). A multidisciplinary team designed new processes to reduce the wait time along with the unnecessary anxiety and number of “sleepless nights” that patients experienced. The team's efforts focused on improving access, service, and patient satisfaction. Compared with baseline, the 2004 yearend results were impressive: 79% of patients were diagnosed within 14 days, with a median of 9 days. As with mammography outreach, the Riverside Service Area has become a KPSC Regional leader in shortening the time-to-service period that follows screening mammography. This accomplishment is particularly noteworthy because the number of procedures performed increased from 23,217 (in 2003) to 27,410 (in 2004).