Purpose: About 400,000 new cases of Head and Neck Cancer (HNC) are diagnosed and reported each year. HNC patients require frequent follow-up care and additional interventions due to the potential for disease recurrence and second primaries. A robust and automated HNC identification and surveillance program can aid in case identification and can track appointments and required care, using the guidelines of the National Comprehensive Cancer Network (NCCN). An automated tool would provide for optimal treatment interventions while preventing any patients from being inadvertently lost to follow-up, enhancing veteran centered care.
Methods: The ear, nose, and throat (ENT) Cancer Tracking System (CTS) queries the VA Corporate Data Warehouse each night to identify all patients recently diagnosed with a HNC. All patients residing in the Albuquerque, New Mexico, and Big Spring, Texas, catchment areas are included in the capture pool. Cases are identified by examining outpatient visits and inpatient discharge diagnosis International Classification of Diseases (ICD) codes, surgical pathology Systematized Nomenclature of Medicine—Clinical Terms (SNOMED codes), and VistA problem list diagnoses. Patients identified as having cancer are presented, using an interactive report hosted on a secure SharePoint site. Newly identified patients are automatically assigned to “active” management status, minimizing the risk of missing a new patient. The coordinator can toggle a patient’s status between “inactive” and “active” at any time, but can never delete a patient from the CTS. Inactive patients with a new cancer diagnosis are automatically toggled to active status. The CTS report tracks and presents a number of pertinent medical indicators, including patient identifiers and residence location, most recent diagnosis date, days since last diagnosis, diagnosis ICD code, date captured on the CTS, most recent ear, nose, and throat (ENT) visit, most recent ENT appointment, days since last visit, date of last thyroid-stimulating hormone (TSH) test, and date of last PET scan. Cancellations, no-shows, and patients overdue for TSH testing are highlighted.
Results: Baseline data obtained in 2012 prior to the activation of the CTS revealed that about 31.1% of diagnosed HNC patients in the ENT clinic experienced delays in care or were lost to follow-up care through cancellations, no shows, and nonrescheduled appointments. A dedicated cancer care coordinator (CCC) was assigned to the ENT clinic to record, monitor, and track HNC patients manually using an Excel spreadsheet. Although cancer surveillance reports proved that launching a cancer surveillance program prevented patients with cancer from being lost to follow-up care, the manual tracking system was time consuming and labor intensive. The automated CTS has optimized cancer surveillance by providing the CCC with immediate identification of new HNC diagnoses, appointment tracking, alerts for HNC patients that have not been scheduled, alerts of overdue required lab tests, tracking of completed PET CT imaging, and improved timeliness in obtaining quality improvement data; all were accomplished without the CCC manually tracking anything.
Conclusions: During the first 4 months of operation (February to May 2014), 14 new HNC patients were identified automatically—patients that manual tracking might have missed or incurred delays in care. The CTS has proved to be a vital tool to the CCC and will continue to assist in the identification of new HNC patients, provide access to patient information on follow-up care, and improve access to recommended diagnostic procedures from NCCN guidelines. Other benefits of an electronic tracking system are optimized time, improved workflows, and improvements to patient safety by providing timely access to care and treatment.