Sikdar Khokan C, Dickinson James, Winget Marcy
Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, G 214 HSC, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
Departments of Family Medicine and Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada.
BMC Health Serv Res. 2017 Jan 5;17(1):7. doi: 10.1186/s12913-016-1944-y.
Although it is well-known that early detection of colorectal cancer (CRC) is important for optimal patient survival, the relationship of patient and health system factors with delayed diagnosis are unclear. The purpose of this study was to identify the demographic, clinical and healthcare factors related to mode of CRC detection and length of the diagnostic interval.
All residents of Alberta, Canada diagnosed with first-ever incident CRC in years 2004-2010 were identified from the Alberta Cancer Registry. Population-based administrative health datasets, including hospital discharge abstract, ambulatory care classification system and physician billing data, were used to identify healthcare services related to CRC diagnosis. The time to diagnosis was defined as the time from the first CRC-related healthcare visit to the date of CRC diagnosis. Mode of CRC detection was classified into three groups: urgent, screen-detected and symptomatic. Quantile regression was performed to assess factors associated with time to diagnosis.
9626 patients were included in the study; 25% of patients presented as urgent, 32% were screen-detected and 43% were symptomatic. The median time to diagnosis for urgent, screen-detected and symptomatic patients were 6 days (interquartile range (IQR) 2-14 days), 74 days (IQR 36-183 days), 84 days (IQR 39-223 days), respectively. Time to diagnosis was greater than 6 months for 27% of non-urgent patients. Healthcare factors had the largest impact on time to diagnosis: 3 or more visits to a GP increased the median by 140 days whereas 2 or more visits to a GI-specialist increased it by 108 days compared to 0-1 visits to a GP or GI-specialist, respectively.
A large proportion of CRC patients required urgent work-up or had to wait more than 6 months for diagnosis. Actions are needed to reduce the frequency of urgent presentation as well as improve the timeliness of diagnosis. Findings suggest a need to improve coordination of care across multiple providers.
虽然众所周知，早期发现结直肠癌（CRC）对患者的最佳生存至关重要，但患者和卫生系统因素与诊断延迟之间的关系尚不清楚。本研究的目的是确定与CRC检测方式和诊断间隔时间相关的人口统计学、临床和医疗保健因素。
从艾伯塔癌症登记处识别出2004年至2010年期间在加拿大艾伯塔省首次诊断为原发性CRC的所有居民。基于人群的行政卫生数据集，包括医院出院摘要、门诊护理分类系统和医生计费数据，用于识别与CRC诊断相关的医疗服务。诊断时间定义为从首次与CRC相关的医疗就诊到CRC诊断日期的时间。CRC检测方式分为三组：紧急、筛查发现和有症状。进行分位数回归以评估与诊断时间相关的因素。
9626名患者纳入研究；25%的患者为紧急情况，32%为筛查发现，43%有症状。紧急、筛查发现和有症状患者的中位诊断时间分别为6天（四分位间距（IQR）2 - 14天）、74天（IQR 36 - 183天）、84天（IQR 39 - 223天）。27%的非紧急患者诊断时间超过6个月。医疗保健因素对诊断时间影响最大：与分别就诊0 - 1次全科医生（GP）或胃肠专科医生相比，就诊3次或更多次GP使中位诊断时间增加140天，而就诊2次或更多次胃肠专科医生使中位诊断时间增加108天。
很大一部分CRC患者需要紧急检查或等待超过6个月才能诊断。需要采取行动减少紧急就诊的频率并提高诊断的及时性。研究结果表明需要改善多个医疗服务提供者之间的护理协调。
