Purpose: Quality improvement project to decrease duration from diagnosis to clinic visit and definitive therapy while improving patient satisfaction within the healthcare system.
Background: Colorectal cancer (CRC) is the second leading cause of death in the United States. VISN Quality, Safety & Value standards were set with objective for all patients with a CRC diagnosis to be seen in a general or colorectal cancer surgery clinic within 30 days. The healthcare system provides oncology care to a large geographic region. The healthcare system instituted CRCspecific navigation in 2016.
Methods: Time from pathologic diagnosis of CRC to initial surgical oncology and/or medical oncology clinic visit was collected from 2013 to 2016 using the Cancer Data Management Program. Pathologic diagnosis was defined as the date when the pathology report was signed. All CRC stages (I-IV) were included, as were inpatients and outpatients. Patient satisfaction surveys were mailed to applicable patients over 3-month period to gauge their experience with nurse navigation. Descriptive statistics were used to analyze data.
Results: The mean (± standard deviation [SD]) time to start of therapy decreased by 12 days between 2016 (36 ± 19 days, n = 22) and 2013 to 2015 (48 ± 32, n = 55) though this did not reach statistical significance (P = .16). Similarly, the mean ± SD time to clinic decreased by 7 days from 2016 (11 ± 10 days) compared with 2013 to 2016 (18 ± 19) (P = .16). The percentage of patients seen within 30 days increased after navigation (95%) compared with prior (85%). Moreover, no patients postnavigation waited 90 or more days to receive therapy compared to 11% before navigation. Patient satisfaction data will be presented.
Conclusions: The implementation of nurse navigation was associated with decrease in mean time to clinic visit, mean time to treatment, and decreased outliers of prolonged time to treatment, though the study’s power was limited to a small sample size. We encourage further investigations into how nurse navigation can be used to improve Veterans’ cancer outcomes.