Quality of diagnostic services for cancer: a comparison of open access and conventional outpatient clinics
C Davies1, G Grimshaw, M Kendall
1Centre for Health Services Studies (CHESS), University of Warwick, Coventry, UK.
Objective And Study Design:
To assess quality of a quick and early diagnosis route (QED) by determining effectiveness and cost-effectiveness of five clinics compared with three conventional outpatient clinics. Prospective economic evaluation. Six-month cohort of all referrals (November 1996-April 1997).
Subjects:
All referrals for suspected cancers of: upper gastro-intestinal tract; urinary tract, prostate and testis; skin.
Effectiveness:
Median days saved between GP referral and date of: diagnostic appointment; consultant decision; intervention.
Results:
GP referral to diagnostic appointment: QED was effective (median days) for all clinics. Diagnostic appointment to consultant decision: QED was effective for testicular and haematuria clinics. Consultant decision to intervention: QED was effective for haematuria, testicular and melanoma clinics.
Cost-Effectiveness:
Extra (incremental) NHS cost per patient diagnosed.
Results:
Less than 5 Pounds per day saved between GP referral and diagnostic appointment for: endoscopy; haematuria; prostate; testicular; melanoma. Less than 3 Pounds per day saved between GP referral and consultant decision for: testicular; haematuria. Less than 3 Pounds per day saved between GP referral and intervention for: endoscopy; haematuria; testicular; melanoma.
Conclusion:
A "quick and early" diagnostic route provides a higher quality service through improved effectiveness and cost-effectiveness compared to conventional outpatients.
