Quality of diagnostic services for cancer: a comparison of open access and conventional outpatient clinics

Abstract

Objective and study design: to assess quality of a quick and early diagnosis route (QED) by determining effectiveness and cost‐ effectiveness of five clinics compared with three conventional outpatient clinics. Prospective economic evaluation. Six‐month cohort of all referrals (November 1996‐April 1997). Subjects: all referrals for suspected cancers of: upper gastro‐intestinal tract; urinary tract, prostate and testis; skin. Effectiveness: median days saved between GP referral and date of: diagnostic appointment; consultant decision; intervention. Results: GP referral to diagnostic appointment: QED was effective (median days) for all clinics. Diagnostic appointment to consultant decision: QED was effective for testicular and haematuria clinics. Consultant decision to intervention: QED was effective for haematuria, testicular and melanoma clinics. Cost‐effectiveness: extra (incremental) NHS cost per patient diagnosed. Results: Less than £5 per day saved between GP referral and diagnostic appointment for: endoscopy; haematuria; prostate; testicular; melanoma. Less than £3 per day saved between GP referral and consultant decision for: testicular; haematuria. Less than £3 per day saved between GP referral and intervention for: endoscopy; haematuria; testicular; melanoma. Conclusion: A “quick and early” diagnostic route provides a higher quality service through improved effectiveness and cost‐effectiveness compared to conventional outpatients.

Cancer Diagnostic Assessment Programs: Standards for the Organization of Care in Ontario

“…The daps may be either actual or virtual entities characterized by facilitated access to comprehensive diagnostic services, multidisciplinary consultative expertise, patient information resources, and psychosocial supports. Programs of this type have been associated with high patient satisfaction [4][5][6][7] , a reduction in time from diagnosis to the initiation of treatment for various disease sites 5,8 , and potentially, improvements in clinical outcomes 9 . However, less clear are the organizational and practice setting features that define a high-quality dap, the role of a dap in a comprehensive rapid-access strategy, the defining features of a dap that lend themselves to unique geographic or jurisdictional situations, and the indicators that should be used to measure quality and impact.…”