Habbous Steven, Khan Yasir, Langer Deanna L, Kaan Melissa, Green Bo, Forster Katharina, Darling Gail, Holloway Claire M B
Clinical Programs and Quality Initiatives, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Ann Thorac Med. 2021 Jan-Mar;16(1):81-101. doi: 10.4103/atm.ATM_283_20. Epub 2021 Jan 14.
Diagnostic assessment programs (DAPs) were implemented in Ontario, Canada, to improve the efficiency of the lung cancer care continuum. We compared the efficiency and effectiveness of care provided to patients in DAPs relative to usual care (non-DAPs).
Lung cancer patients diagnosed between 2014 and 2016 were identified from the Ontario Cancer Registry. Using administrative databases, we identified various health-care encounters 6 months before diagnosis until the start of treatment and compared utilization patterns, timing, and overall survival between DAP and non-DAP patients.
DAP patients were younger ( < 0.0001), had fewer comorbidities ( = 0.0006), and were more likely to have early-stage disease (36% vs. 25%) than non-DAP patients. Although DAP patients had a similar time until diagnosis as non-DAP patients, the time until treatment was 8.5 days shorter for DAP patients. DAP patients were more likely to receive diagnostic tests and specialist consultations and less likely to have duplicate chest imaging. DAP patients were more likely to receive brain imaging. Among early-stage lung cancers, brain imaging was high (74% for DAP and 67% for non-DAP), exceeding guideline recommendations. After adjustment for clinical and demographic factors, DAP patients had better overall survival than non-DAP patients (hazard ratio [HR]: 0.79 [0.76-0.82]), but this benefit was lost after adjusting for emergency presentation (HR: 0.96 [0.92-1.00]). A longer time until treatment was associated with better overall survival.
DAPs provided earlier treatment and better access to care, potentially improving survival. Quality improvement opportunities include reducing unnecessary or duplicate testing and characterizing patients who are diagnosed emergently.
加拿大安大略省实施了诊断评估项目（DAPs），以提高肺癌治疗连续过程的效率。我们比较了DAPs中患者与常规治疗（非DAPs）患者所接受治疗的效率和效果。
从安大略癌症登记处识别出2014年至2016年间确诊的肺癌患者。利用行政数据库，我们确定了诊断前6个月直至治疗开始期间的各种医疗接触情况，并比较了DAP患者和非DAP患者的医疗利用模式、时间安排和总生存期。
与非DAP患者相比，DAP患者更年轻（P<0.0001），合并症更少（P = 0.0006），且更有可能患有早期疾病（36%对25%）。尽管DAP患者从诊断到治疗的时间与非DAP患者相似，但DAP患者从诊断到治疗的时间短8.5天。DAP患者更有可能接受诊断检查和专科会诊，且重复进行胸部成像的可能性较小。DAP患者更有可能接受脑部成像检查。在早期肺癌患者中，脑部成像检查的比例较高（DAP患者为74%，非DAP患者为67%），超过了指南建议。在对临床和人口统计学因素进行调整后，DAP患者的总生存期优于非DAP患者（风险比[HR]：0.79[0.76 - ），但在对急诊就诊情况进行调整后，这种益处消失了（HR：0.96[0.92 - 1.00]）。从诊断到治疗的时间越长，总生存期越好。
DAPs提供了更早的治疗和更好的医疗服务可及性，可能改善生存率。质量改进机会包括减少不必要或重复的检查，以及对急诊确诊的患者进行特征描述。
