Timeline analysis of adjuvant therapy timing in colorectal cancer to improve adherence to the 120-day quality measure.

Abstract

729 Background: Multiple organizations, including ASCO, have developed accountability quality of cancer care measures that have been incorporated into accreditation, managed care contracts and quality monitoring. Institutional adherence to adjuvant chemotherapy (chemo) for stage III colon cancer (CC) provided within 120 days of diagnosis (Dx) is one such measure. We previously reported our institutional experience with reasons for non-adherence to this measure. We undertook an in-depth comparison of the clinical management timeline in adherent (A) and non-adherent (NA) cases to identify potential areas for process improvement to address this issue. Methods: All CC cases reported at a single institution from 2008–2012 were reviewed using ACS Commission on Cancer coding standards. Student t-test was used for statistical comparisons. Results: Of the 122 measure-eligible cases 16 (13.1%) were deemed NA. Of NA cases, 2(12.5%) were lost to follow up and 14(87.5%) received delayed chemo. In NA cases, the mean time from initial Dx to chemo was 159.5(+/-51) days vs. 68.7(+/-24.5) days in A cases (p=2x10-6). The Table reports the mean interval times between diagnosis, initial visit, surgery, medical oncology consultation, and receipt of chemo. The most significant differences between A and NA cases were in the pre-operative time period and related to obtaining the initial consultation and subsequent surgical treatment. Conclusions: Treatment timeline analysis revealed the most prominent delays were time to initial presentation and to surgical intervention. These areas could potentially be addressed by measure awareness, streamlining of scheduling and improved inter-provider communication. With the inevitable implementation of such measures, institutions may benefit from similar systematic evaluations for process improvement. [Table: see text]