A pilot program developed by researchers at Yale Cancer Center that offers patients next day access (NDA) for oncologic consultation showed reduced wait times for initial access to cancer care and increased patient satisfaction, according to a new report. The study data will be presented on Sept. 24, at the 2021 American Society of Clinical Oncology (ASCO) Quality Care Symposium.
“Delays in access to treatment have been shown to cause anxiety and distress in patients with cancer and even more troublesome, worse outcomes,” said Dr. Sarah Mougalian, associate professor of medicine (medical oncology) and deputy chief ambulatory officer at Smilow Cancer Hospital and Yale Cancer Center and lead author of the study. “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 NDA program developed by Mougalian and colleagues offered oncologic consultation within one business day in two subspecialty clinics and two Smilow Cancer Hospital Care Center Network sites. Each pilot team created an implementation plan for breast and gynecological cancer patients, with algorithms defining which patients are “eligible” for NDA. Patients seen via NDA completed a brief anonymous survey regarding their experience.
Over seven 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 NDA. 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 NDA included: specific provider requested (41%), specific date requested (23%), unavailable next day appointment (6%). Cultural barriers, particularly from treating physicians, included feeling that NDA 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 six to 20 days one year later.
“Success of this pilot required extensive effort to address change management and perceived barriers, but the results are very encouraging,” said Mougalian. “Deployment in other disease teams and at additional community sites is underway.” Other Yale authors involved in the study include: Lisa Shomsky, Maureen Major Campos, and Anne C. Chiang.