Using Electronic Data to Improve Care of Patients with Known or Suspected Cancer

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DESCRIPTION (provided by the applicant): Patients with known or suspected cancers transition through several different settings of ambulatory care in order to receive a timely diagnosis and treatment. The survival benefit conferred by early diagnosis and treatment hinges on well-coordinated care. Our preliminary work, for instance, shows that breakdowns in care processes that occur while patients are navigating the ambulatory care system can lead to substantial delays in diagnosis and/or treatment of some cancers. The goal of this proposal is to test the use of health information technology (IT) to identify patients with these delays and facilitate their movement through the health care system. The Institute of Medicine has identified both timeliness and coordination of care as targets for improving health care quality. However, little or no other published literature addresses a comprehensive approach to prevent breakdowns and delays in cancer diagnosis and/or treatment related to high risk ambulatory care transitions. In this study, we will use health IT to address these issues in five cancers for which early detection may improve survival (colon, lung, breast, prostate, and cervical cancer). We will build upon our previous and ongoing work in innovative data mining techniques to identify patients likely to have delays in cancer diagnosis or treatment, and we will facilitate their care processes using electronic communication and surveillance. The hypothesis of this prospective randomized controlled trial is that IT-based interventions can reduce delays and missed opportunities as compared to usual care. Our specific aims are: Aim 1: To identify patients with cancer-related diagnostic and treatment delays using "trigger" based data mining of an electronic health records repository. Aim 2: To determine the effectiveness of an IT-based intervention (consisting of data mining using triggers tested in Aim 1 followed by targeted electronic communication and surveillance techniques) to expedite cancer diagnosis and treatment initiation as compared with usual care. In Aim 1, we will test the use of new triggers to identify patients with delays, and conduct chart reviews to determine their utility and improve them. In Aim 2, we will recruit providers on a voluntary basis and randomize them to intervention or controls. Providers in the intervention group will receive electronic communications and surveillance if potential delays on their patients are identified by triggers. Outcome measures, obtained through chart review, will consist of time intervals between several key steps in the optimal pathway of care and timeliness of diagnosis and treatment initiation among patients either diagnosed with or suspected of cancer. The research settings include an urban Veterans Affairs facility and a large primary care network representing internal and family medicine practitioners, academic and nonacademic practices, urban and rural patients, and significant racial, gender, ethnic, age, and socioeconomic patient diversity. In future, our findings could be integrated with cancer navigation programs and increase their efficiency. They could also inform the design of similar interventions to improve the management of other serious chronic conditions.