Journal article
Characteristics and Predictors of Missed Opportunities in Lung Cancer Diagnosis: An Electronic Health Record–Based Study
Journal of clinical oncology, Vol.28(20), pp.3307-3315
07/10/2010
DOI: 10.1200/JCO.2009.25.6636
PMCID: PMC2903328
PMID: 20530272
Abstract
Purpose Understanding delays in cancer diagnosis requires detailed information about timely recognition and follow-up of signs and symptoms. This information has been difficult to ascertain from paper-based records. We used an integrated electronic health record (EHR) to identify characteristics and predictors of missed opportunities for earlier diagnosis of lung cancer. Methods Using a retrospective cohort design, we evaluated 587 patients of primary lung cancer at two tertiary care facilities. Two physicians independently reviewed each case, and disagreements were resolved by consensus. Type I missed opportunities were defined as failure to recognize predefined clinical clues (ie, no documented follow-up) within 7 days. Type II missed opportunities were defined as failure to complete a requested follow-up action within 30 days. Results Reviewers identified missed opportunities in 222 (37.8%) of 587 patients. Median time to diagnosis in cases with and without missed opportunities was 132 days and 19 days, respectively (P < .001). Abnormal chest x-ray was the clue most frequently associated with type I missed opportunities (62%). Follow-up on abnormal chest x-ray (odds ratio [OR], 2.07; 95% CI, 1.04 to 4.13) and completion of first needle biopsy (OR, 3.02; 95% CI, 1.76 to 5.18) were associated with type II missed opportunities. Patient adherence contributed to 44% of patients with missed opportunities. Conclusion Preventable delays in lung cancer diagnosis arose mostly from failure to recognize documented abnormal imaging results and failure to complete key diagnostic procedures in a timely manner. Potential solutions include EHR-based strategies to improve recognition of abnormal imaging and track patients with suspected cancers.
Details
- Title: Subtitle
- Characteristics and Predictors of Missed Opportunities in Lung Cancer Diagnosis: An Electronic Health Record–Based Study
- Creators
- Hardeep Singh - From Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Iowa City Veterans Administration Medical Center; and University of Iowa Carver College of Medicine, Iowa City, IAKamal Hirani - From Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Iowa City Veterans Administration Medical Center; and University of Iowa Carver College of Medicine, Iowa City, IAHimabindu Kadiyala - From Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Iowa City Veterans Administration Medical Center; and University of Iowa Carver College of Medicine, Iowa City, IAOlga Rudomiotov - From Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Iowa City Veterans Administration Medical Center; and University of Iowa Carver College of Medicine, Iowa City, IATraber Davis - From Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Iowa City Veterans Administration Medical Center; and University of Iowa Carver College of Medicine, Iowa City, IAMyrna M Khan - From Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Iowa City Veterans Administration Medical Center; and University of Iowa Carver College of Medicine, Iowa City, IATerry L Wahls - From Houston Veterans Affairs Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX; Iowa City Veterans Administration Medical Center; and University of Iowa Carver College of Medicine, Iowa City, IA
- Resource Type
- Journal article
- Publication Details
- Journal of clinical oncology, Vol.28(20), pp.3307-3315
- DOI
- 10.1200/JCO.2009.25.6636
- PMID
- 20530272
- PMCID
- PMC2903328
- NLM abbreviation
- J Clin Oncol
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Language
- English
- Date published
- 07/10/2010
- Academic Unit
- Neurology; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984020741302771
Metrics
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