Blog Post

Timeliness of follow-up after abnormal breast and lung cancer screening: How do you compare to your peers?

By Ashley Riley

November 4, 2020

    Timeliness of care after an abnormal cancer screening is a key quality metric for cancer programs. Moving patients through the diagnostic pathway efficiently can be challenging but is critical to providing high-quality care and capturing patients in your system.

    We analyzed Medicare data from 2018 to understand the typical timelines between screening and first treatment for breast and lung cancer. For breast cancer patients, we limited the analysis to patients who received downstream diagnostic or treatment services within six months of a screening mammogram that took place in 2018. For lung cancer patients, we extended this window to 12 months between a low-dose CT (LDCT) and downstream diagnostic or treatment services. View the codes we used to define each procedure here.

    To complete the analysis, we used CMS' Carrier File, which is a 5% representative sample of all fee-for-service Medicare claims submitted by non-institutional providers such as physicians, nurse practitioners, clinical laboratories, ambulance services, suppliers, and some stand-alone facilities such as ambulatory surgical centers. The claims follow patients' care through the physician office, hospital outpatient, and inpatient settings.

    Fastest part of breast diagnostic pathway is between diagnostic mammogram and breast biopsy

    For patients who underwent a diagnostic or treatment service within six months of a screening mammogram, the median number of days between screening mammogram and diagnostic mammogram was 12 days, between diagnostic mammogram and breast biopsy was 8 days, and between biopsy and breast surgery was 34 days. The figure below depicts the percentage of screening mammogram patients who received each downstream procedure, represented by the size of the circle, as well as the median number of days between each procedure.

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    Tracking the time between the screening mammogram and each individual procedure, rather than the time between each procedure in succession, revealed that the median number of days from a screening mammogram to breast biopsy was 23 days, and from screening mammogram to surgery was 55 days.

    Diagnostic mammogram and breast biopsy are the most common same-day procedures

    In recent years, we've seen more interest in offering same-day procedures to breast cancer screening patients, which can be a differentiator for programs looking to improve patient experience and timeliness of care. According to our analysis, diagnostic mammograms and breast biopsies are the most common services received on the same day. The graphs below show the rate of same-day procedures and the distribution of the time between procedures.

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    Read our 2016 Medicare data analysis of procedures downstream of a screening mammography

    Fastest part of lung diagnostic pathway is between diagnostic procedure and first treatment 

    The time between screening to the start of the first treatment is significantly longer for lung cancer than for breast cancer. There are likely many factors that contribute to this difference, particularly differences in the diagnostic pathways and practices for these distinct diseases. For patients who underwent a diagnostic or treatment service within 12 months of a screening LDCT, the median number of days between screening LDCT and diagnostic procedure was 59 days and between a diagnostic procedure and first treatment was 35 days.

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    According to our data, 3.3% of patients who received a LDCT underwent a diagnostic procedure and 1.7% of patient who received a LDCT underwent a first-line treatment for lung cancer. For those patients who received a LDCT and subsequent treatment, the median number of days between screening LDCT and first treatment was 89 days.

    Time between lung screening and diagnostic procedures varies most across patients

    The plots below show the distribution of days between a screening LDCT and diagnostic procedure and between a diagnostic procedure and first treatment for all patients who received a screening LDCT. There is significantly more variation in the number of days between a screening and diagnostic procedure across patients, with a difference of 158 days between the 25th percentile and the 75th percentile (often referred to as the interquartile range or IQR).

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    In comparison, there was only a difference of 37 days between the 25th percentile and the 75th percentile for the number of days between receiving a lung cancer diagnostic procedure and first course treatment. The minimum number of days between these two procedures is zero days, indicating some patients receive them on the same day.

    Toolkit: Here’s everything you need to build a stronger lung screening program

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    Benchmark your organization's performance against national data to identify areas for improvement  

    Based on how your organization's timeliness compares to the national data from our analysis, identify and implement targeted strategies to improve performance at specific portions along the breast and lung diagnostic pathways where your organization lags behind.

    OhioHealth, for example, was able to reduce the time from detection of a breast abnormality to diagnosis from 25 to eight days by hiring diagnostic breast health navigators. These diagnostic navigators receive a daily report via their Epic EHR of all abnormal mammograms. They will then call these patients to walk them through their results and help schedule additional imaging or biopsies. The diagnostic navigators also coordinate with the patient's primary care provider and biopsy surgeon to help facilitate communication and appropriate scheduling. In addition to providing logistical support, these navigators assess patient stress, provide education, and answer patient questions throughout the diagnostic process. Due to the success of the diagnostic breast health nurse navigators, OhioHealth is currently in the process of building out diagnostic navigation touchpoints for colorectal and lung cancer patients as well.

    Please note that since this analysis is based off a representative 5% sample of national Medicare beneficiaries, the downstream procedure rates given here should be considered alongside your population's clinical and demographic characteristics.

    Facing a backlog of cancer screenings? Here's how to dig out.

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    With the onset of Covid-19 increasing cancer screening backlogs, efficient and timely care is more important than ever.

    Check out our recent blog on effective strategies to dig out of your organization's backlog.

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