AHRQ Study: Using Electronic Triggers Can Speed Cancer Diagnosis

Electronic prompts can reduce the time it takes to diagnose colorectal and prostate cancer, as well as improve follow-up care, a new AHRQ-funded study found. The same kind of intervention could improve the timeliness of diagnosis of other serious conditions, the authors stated. Published online August 24 in the Journal of Clinical Oncology, the article described how using electronic health records (EHRs) helped primary care providers test for cancer earlier, thus improving diagnostic safety. The researchers tested whether the use of EHR-based “trigger” algorithms to identify patients at risk of diagnostic delays could reduce the time it takes to identify the need for cancer testing. They studied 72 primary care providers and records for an estimated 118,400 patients under their care from April 2011 to July 2012. Red-flag criteria were found in 10,673 records; of those, 11.8 percent were verified as at high risk for delayed diagnostic evaluation. Read the abstract for the study, “An Electronic Trigger-Based Intervention to Reduce Delays in Diagnostic Evaluation for Cancer.”

2015 Aug 24. pii: JCO.2015.61.1301. [Epub ahead of print]

Electronic Trigger-Based Intervention to Reduce Delays in Diagnostic Evaluation for Cancer: A ClusterRandomized Controlled Trial.

Murphy DR1, Wu L1, Thomas EJ1, Forjuoh SN1, Meyer AN1, Singh H2.

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Abstract

PURPOSE:

We tested whether prospective use of electronic health record-based trigger algorithms to identify patients at risk of diagnostic delayscould prevent delays in diagnostic evaluation for cancer.

METHODS:

We performed a cluster randomized controlled trial of primary care providers (PCPs) at two sites to test whether triggers that prospectively identify patients with potential delays in diagnostic evaluation for lung, colorectal, or prostate cancer can reduce time to follow-updiagnostic evaluation. Intervention steps included queries of the electronic health record repository for patients with abnormal findings and lack of associated follow-up actions, manual review of triggered records, and communication of this information to PCPs via secure e-mail and, if needed, phone calls to ensure message receipt. We compared times to diagnostic evaluation and proportions of patients followed up between interventionand control cohorts based on final review at 7 months.

RESULTS:

We recruited 72 PCPs (36 in the intervention group and 36 in the control group) and applied the trigger to all patients under their care from April 20, 2011, to July 19, 2012. Of 10,673 patients with abnormal findings, the trigger flagged 1,256 patients (11.8%) as high risk for delayeddiagnostic evaluation. Times to diagnostic evaluation were significantly lower in intervention patients compared with control patients flagged by the colorectal trigger (median, 104 v 200 days, respectively; n = 557; P < .001) and prostate trigger (40% received evaluation at 144 v 192 days, respectively; n = 157; P < .001) but not the lung trigger (median, 65 v 93 days, respectively; n = 19; P = .59). More intervention patients than control patients received diagnostic evaluation by final review (73.4% v 52.2%, respectively; relative risk, 1.41; 95% CI, 1.25 to 1.58).

CONCLUSION:

Electronic trigger-based interventions seem to be effective in reducing time to diagnostic evaluation of colorectal and prostate canceras well as improving the proportion of patients who receive follow-up. Similar interventions could improve timeliness of diagnosis of other serious conditions.