A pilot program developed by researchers at Yale Cancer Center that offers patients next-day access for oncologic consultation showed reduced wait times for initial access to cancer care and increased patient satisfaction, according to a new report presented by Mougalian et al at the 2021 ASCO Quality Care Symposium (Abstract 205).
“Delays in access to treatment have been shown to cause anxiety and distress in patients with cancer and even more troublesome, worse outcomes,” said lead study author Sarah Mougalian, MD, Associate Professor of Medicine (Medical Oncology) and Deputy Chief Ambulatory Officer at Smilow Cancer Hospital and Yale Cancer Center. “It is critical to implement interventions that enhance navigation, improve access to cancer care, and eliminate operational and cultural barriers to prompt establishment of care and subsequent treatment initiation.”
The next-day access program developed by Dr. Mougalian and colleagues offered oncologic consultation within 1 business day in two subspecialty clinics and two Smilow Cancer Hospital Care Center Network sites. Each pilot team created an implementation plan for patients with breast and gynecologic cancers, with algorithms defining which patients are “eligible” for next-day access. Patients seen via the program completed a brief anonymous survey regarding their experience.
Over 7 months, 3,107 new patients were seen across the four pilot sites, 900 (29.8%) of whom met “next-day appropriate” criteria, and 370 (12%) of whom were seen via next-day access. Patient satisfaction was extremely high, with 96% indicating that expectations were met or exceeded. Over half (56%) responded that a timely appointment was important when choosing cancer care. The most common reasons patients were not seen via next-day access were specific provider request (41%), specific date request (23%), and unavailable next-day appointment (6%). Cultural barriers, particularly from treating physicians, included feeling that next-day access appointments were inefficient with incomplete data, less time for clinical review, and increased burden due to last-minute new patients; operational challenges included insufficient staffing and ensuring complete/accurate data collection. From December 2019 through February 2020, median time to first visit ranged from 17 to 36 days; median time to first visit decreased in three of the four pilot sites to 6 to 20 days 1 year later.
“Success of this pilot required extensive effort to address change management and perceived barriers, but the results are very encouraging,” said Dr. Mougalian. “Deployment in other disease teams and at additional community sites is underway.”
Disclosure: For full disclosures of the study authors, visit coi.asco.org.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.