In an effort to decrease the timeline from suspicion and/or cancer diagnosis to treatment, the Oncology Disease Management RNs incorporated a streamlined and integrated clinical approach. A Disease Case Management (DM) team model is a useful approach to enhance the veteran experience and expedite health care delivery. In 2007, the DM program was begun. The team consisted of 3 registered nurses (RN) who worked under the Quality Management Department rather than the oncology clinic in order to have a more wide ranged approach in both treatment and interventions.
Methods: All patients who had either a suspicion for, or an actual diagnosis of cancer were followed by the DM RNs. We assessed the timeline in days for veterans to get scheduled for recommended tests and consults before and after the DM team involvement. We reviewed timeline data for patients diagnosed during fiscal years 2009 to 2015. The percentage change was calculated for Oncology Consults and Intra-facility Consults to DM team. Times from diagnosis to treatment intervention pre and post DM implementation were reviewed for Primary liver, colon and lung cancers.
Results: Rate of change: Oncology consults for Disease Management team intervention: 62% increase. Reduction in time from diagnosis to treatment intervention: Colon cancer and Lung Cancer 50% and 46% respectively. Reduction in the time required for getting primary Liver cancer patients into diagnostic tests and tumor board presentations for treatment intervention – days shortened from 92 to 31 days from baseline data 2010/11 to 2015. This reflected a 66% decrease in time to treatment /intervention.
Conclusion: The data reflect that in a VA healthcare setting, the Disease Management team model is feasible for facilitating an integrated and coordinated approach in reducing timelines for treatment. The data support that the early introduction of the disease management team model shortened the number of days from diagnosis to treatment by facilitating referrals, clinical testing, and/or treatment initiation in Veteran cancer patients resulting in timely care intervention.
