Examining the pathway to diagnosis and treatment of lymphoma in Manitoba: patient and system factors resulting in delay
The province of Manitoba has set a goal of reducing time from suspicion of cancer to treatment to a target of sixty days. To attain this goal, a baseline understanding of current time intervals is required. This study examined system, diagnostic and treatment delay in adult patients (> 17) diagnosed with Lymphomas from 2005 to 2010 using administrative data (Manitoba Cancer Registry, Manitoba Health billing data and Hospital Abstract data) and a chart review of a random subset of patients. A triangulated data approach was used to identify suspicion of lymphoma and milestones in the patient journey and to measure delays in diagnosis and treatment. Using an iterative consultative process, an algorithm was built to identify index events likely related to subsequent lymphoma diagnosis. Then, claims data was searched for a referring provider for each index event. The last visit with a referring provider, prior to the first index event, was selected as date of high suspicion. The study found that 14.8% of patients met the provincial target of less than sixty days from suspicion to treatment. Median time from high suspicion to treatment, referred to as system delay, was 128 days and the median time from diagnosis to treatment was 41 days. Time to diagnosis accounted for two thirds of system delay. In conclusion, this study demonstrated the merit of a triangulated approach. As well the clinical pathway developed and the target timelines for milestones have operational value and can be used to direct process improvements to shorten delays for future patients.
Lymphoma, delay, clinical pathway