P1-11-13: Improvement in the Quality of Care for Patients with Locally Advanced Breast Cancer through Implementation of an Integrated Electronic Care Pathway.

Abstract

Abstract Background: Locally advanced breast cancer (LABC) refers to the most advanced stage of non-metastatic tumours with an incidence of approximately 10% in newly diagnosed breast cancers. Currently, for optimal care, patients with LABC require a multidisciplinary approach including coordinated planning with medical, surgical and radiation oncologists. Many barriers may exist in co-ordinating timely management of these patients. Care pathways are important tools to streamline care and data collection and feedback allows for quality improvement in clinical practice. We created an interactive electronic care pathway and self populating quality assurance database at St. Michael's Hospital (SMH) to facilitate multidisciplinary teams to track LABC patient histories and patient treatments in order to coordinate therapy effectively and expedite care (LABC E-PATH). Methods: This is an observational before-and-after cohort study of patients with LABC with a retrospective review pre-implementation and prospective collection of clinical data post-implementation. The completeness of workup and the timeliness of treatment pre- and post-implementation were assessed. Results: With the implementation of the LABC E-PATH in May 2010, the time between the referral of an LABC patient to a medical oncologist and consultation has decreased from 7 days (range 0 to 493) pre-implementation to 2 days (range 0 to 29) post-implementation. The time between referral to medical oncologist and the start of their chemotherapy treatment decreased significantly from a median of 19 days to 8 days (pre-implementation: range = 0 to 493, postimplementation: range = 0 to 128) (p=0.0028). All pre-treatment staging was completed faster post-implementation of the LABC e-path than pre-implementation, expediting time to initiation of chemotherapy. The number of referrals for LABC to the SMH program increased from < 1 patient per month to 4 patients per month post-implementation. Conclusions: The LABC E-PATH has achieved its goal of expediting care and overcoming barriers to timely treatment in this patient population. It has also ensured timely and appropriate resource allocation. This unique system may also be applied to other disease sites where coordination of a multi-disciplinary team is critical for appropriate patient management. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-11-13.