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Timely access and quality of care in colorectal cancer: are they related?
Yarrow J McConnell1, Karen Inglis, Geoff A Porter
1Division of General Surgery, QEII Health Sciences Centre, Dalhousie University, 1278 Tower Rd., Halifax, Nova Scotia, Canada.
Objective:
Colorectal cancer patients want both timely access and high-quality care. The objective of this study was to explore relationships between quality indicators and access time intervals specific to colorectal cancer patients.
Design:
Prospective consecutive cohort study.
Setting:
Single health district.
Participants:
Between February 2002 and February 2004, all patients undergoing non-emergent surgery for primary colorectal cancer were enrolled.
Intervention:
A standardized method was used to collect clinicodemographic, diagnostic and treatment event data.
Main Outcome Measures:
Associations between accepted colorectal cancer-specific quality indicators and benchmarked access time intervals for diagnosis, surgery and adjuvant therapy were examined using multivariate logistic regression, controlling for clinicodemographic factors.
Results:
Among the 392 patients in the study cohort, 9.9% were diagnosed on screening examination, 53.1% underwent preoperative staging imaging and 74.5% underwent full preoperative colonic examination. On multivariate logistic regression, patients presenting via screening were more likely to move from presentation to diagnosis within the 4-week benchmark for this access time interval, compared with symptomatic patients (RR 8.1, P < 0.001). The absence of preoperative staging imaging was associated with achievement of the 4-week benchmark for the access time interval from diagnosis to surgery (RR 2.5, P < 0.001). Similarly, an absence of complete preoperative colonic examination was associated with achievement of the 8-week benchmark for the access time interval from surgery to adjuvant therapy (RR 6.6, P = 0.008).
Conclusions:
Although several associations between quality indicators and benchmarked access time intervals for colorectal cancer patients were identified, the relationship between quality and access is complex and far from universal. It is therefore clear that quality care and timely access are not synonymous, and that both must be studied to improve colorectal cancer care.
