Using Literature Review and Structured Hybrid Electronic/ Manual Mortality Review to Identify System-Level...

Area of Science:

• Oncology
• Public Health
• Healthcare Systems Improvement

Background:

• Colorectal cancer (CRC) screening and survival rates at Kaiser Permanente Southern California (KPSC) exceeded national averages.
• KPSC sought system-level improvements to further decrease CRC mortality.

Purpose of the Study:

• To identify modifiable factors contributing to CRC mortality within the KPSC system.
• To pinpoint specific areas for intervention to reduce CRC-related deaths.

Main Methods:

• A hybrid electronic/manual mortality review of 50 randomly selected CRC cases (stage II-IV) was conducted.
• Physicians reviewed patient charts using a standardized tool based on best practices.

Main Results:

• 31% of cases had no prior CRC screening; 15% presented with key symptoms but no screening history.
• Delayed chemotherapy initiation and missed surgical oncology evaluations were noted in advanced-stage patients.
• Inadequate surveillance post-surgery and missed reporting of pathology findings represented further opportunities for improvement.

Conclusions:

• Multiple care stages present opportunities for improvement in CRC mortality reduction.
• Key areas include enhancing CRC screening, symptom evaluation, treatment timeliness, adjuvant chemotherapy delivery, and surgical oncology coordination.