a Center for Primary Health Care Research , Lund University/Region Skåne , Malmö , Sweden.
b Regional Cancer Centre South, Region Skåne , Lund , Sweden.
Acta Oncol. 2019 Mar;58(3):296-305. doi: 10.1080/0284186X.2018.1537506. Epub 2019 Jan 11.
Fast-track referral is an increasingly used method for diagnostic evaluation of patients suspected of having cancer. This approach is challenging and not used as often for patients with only nonspecific symptoms. In order to expedite the diagnostics for these patients, we established Sweden's first Diagnostic Center (DC) focusing on outcomes related to diagnoses and diagnostic time intervals.
The study was designed as a prospective cohort study. Patients aged ≥18 years who presented in primary care with nonspecific symptoms of a serious disease were eligible for referral to the DC after having completed an initial investigation. Acceptable diagnostic time intervals were defined to be a maximum of 15 days in primary care and 22 days at the DC. Diagnostic outcome, length of diagnostic time intervals and patient satisfaction were evaluated.
A total of 290 patients were included in the study. Cancer was diagnosed in 22.1%, other diseases in 64.1%, and no diagnosis was identified in 13.8% of these patients. Patients diagnosed with cancer were older, had shorter patient interval (time from first symptom to help-seeking), shorter DC-interval (time from referral decision in primary care to diagnosis) and showed a greater number of symptoms compared to patients with no diagnosis. The median primary care interval was 21 days and the median DC interval was 11 days. Few symptoms, no diagnosis, female sex, longer patient interval, and incomplete investigations were associated with prolonged diagnostic time intervals. Patient satisfaction was high; 86% of patients reported a positive degree of satisfaction with the diagnostic procedures.
We demonstrated that the DC concept is feasible with a diagnosis reached in 86.2% of the patients in addition to favorable diagnostic time intervals at the DC and a high degree of patient satisfaction.
快速转诊是一种越来越多地用于评估疑似癌症患者的诊断方法。这种方法具有挑战性，对于仅有非特异性症状的患者并不常用。为了加快这些患者的诊断速度，我们建立了瑞典第一个专注于诊断结果和诊断时间间隔的诊断中心（DC）。
该研究设计为前瞻性队列研究。在初级保健中出现严重疾病非特异性症状的年龄≥18 岁的患者，在完成初步检查后，有资格转至 DC。可接受的诊断时间间隔定义为在初级保健中最长 15 天，在 DC 中最长 22 天。评估诊断结果、诊断时间间隔和患者满意度。
共有 290 名患者纳入研究。这些患者中 22.1%被诊断为癌症，64.1%被诊断为其他疾病，13.8%未被诊断。与未被诊断的患者相比，被诊断为癌症的患者年龄更大，患者间隔（从首次症状到寻求帮助的时间）更短，DC 间隔（从初级保健转诊决定到诊断的时间）更短，并且表现出更多的症状。初级保健间隔的中位数为 21 天，DC 间隔的中位数为 11 天。少数症状、无诊断、女性、较长的患者间隔和不完全检查与诊断时间间隔延长有关。患者满意度很高；86%的患者报告对诊断过程有积极的满意度。
我们证明了 DC 概念是可行的，除了在 DC 达到 86.2%的诊断率以及患者满意度高之外，还具有有利的诊断时间间隔。
