Editor's note: This popular story from the Daily Briefing's archives was republished on Jan. 2, 2020.
Cleveland Clinic cut the time between a cancer patient's initial diagnosis and first treatment by 33% in the five years after it launched targeted, multidisciplinary programs, Alok Khorana, the vice chair of clinical services for Cleveland Clinic's Taussig Cancer Institute, and Brian Bolwell, chair of the Taussig Cancer Institute, write in NEJM Catalyst.
According to Khorana and Bolwell, research shows newly diagnosed cancer patients can wait more than six weeks at large academic medical centers to receive their first treatment. That's a problem, Khorana and Bolwell write, because "[d]elays in time-to-treatment have potentially been associated with worsened survival in certain cancers, particularly in early stages," as well as "anxiety and distress" among patients.
"[T]o address this health care delivery issue," the Cleveland Clinic in 2014 launched a series of programs to "reduce median time-to-treatment from [the clinic's] baseline of 39 days across all cancers to [fewer than] 30 days," Khorana and Bolwell write.
The programs initially focused on high-volume cancers, such as genitourinary and breast cancer. Each program targeted a specific type of cancer and included a multidisciplinary team consisting of two leaders from different specialties—typically medical and surgical oncology—and prioritized collecting metrics on time-to-treatment.
Khorana and his colleagues "found … separately focusing on different disease entities was helpful because barriers to access and coordinated care" differed substantially for different types of cancer. For instance, Khorana and Bolwell note how "a plastic surgeon early in treatment planning was important in localized breast cancer, but not required in rectal cancer, where the focus was on integrating care with the radiation therapy team."
But Khorana and Bolwell also note that "many barriers to reducing time-to-treatment were shared between disease sites." So they developed a reporting structure to allow each program "to learn from one another's successes and failures."
For example, Khorana and Bolwell write that the breast cancer program found communication gaps between surgery schedulers and medical oncology "delay[ed the] initiation of therapy." To fix those gaps, the team "developed a weekly face-to-face huddle between schedulers." The huddle helped reduce delays, and other programs eventually adopted the same approach.
Overall, the groups identified several reasons for delays in treatment, including:
Based on their findings, Khorana and Bolwell decided to hire program managers to partner with the leaders of each group to support the separate programs, which reduced the administrative burden placed on physicians. They also found they needed to hire new staff to coordinate patient access and follow-up visits between specialties.
Since the programs' launch, the median number of days between a patient's cancer diagnosis and first treatment at Cleveland Clinic has decreased from a baseline rate of:
The clinic also saw the proportion of patients experiencing delays longer than 45 days across all the clinic's cancer programs fall by 53%, from a baseline rate of 30% to 14%.
Khorana and Bolwell write that the program provided "additional value in the organizational development … as it led to clinical alignment across a complex health care delivery system," as well as "more physician engagement and … more uniform, higher-quality, and cost-effective clinical care."
Khorana and Bolwell write that cancer centers looking to reduce the time it takes for cancer patients to receive their first treatments must first understand the access points cancer patients use to seek care. After that, centers should:
Deirdre Saulet, Practice Manager, Oncology Roundtable
“96% of referring physicians rank appointment timeliness as "extremely important" in their referral decision.”
A long turnaround time from suspicious finding to diagnosis to treatment start can have significant clinical implications (like increased patient anxiety and even worse outcomes for certain diagnoses), in addition to important financial implications for providers. Cancer programs with long wait times risk losing referrals—in one survey, 96% of referring physicians rank appointment timeliness as "extremely important" in their referral decision. Not to mention, as patients become increasingly self-directed, they are more likely to spend time Googling other options if they have to wait a long time to speak with or see someone at your organization.
In the past, many cancer programs were able to add staff or expand their facilities to improve access, but tightening margins and workforce shortages make those investments difficult today. To address the underlying barriers to timely care, programs must focus—like Cleveland Clinic did—on making process improvements and redesigning care pathways.
Through our research, we've identified four steps for programs to reduce patient wait times—both for their first appointment and during subsequent appointments:
To get a sense of the metrics you should be tracking, as well as benchmarks for different types of programs, be sure to visit our Scheduling Improvement Toolkit.
Want to know more about how to support newly diagnosed patients? Oncology Roundtable members shouldn't miss our national meeting where we'll discuss newly diagnosed patients' preferences and priorities, along with strategies for you to provide them support when they need it the most.
We've also done much more research on the how cancer programs can improve their appointment timeliness and assembled best practices on how to optimize patient throughput in order to increase capacity and decrease delays in care. To learn more about the tactics we'd suggest, be sure to read our report on offering Timely Care for Oncology Patients.
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