Background: As adjuvant treatment moves to outpatient settings, required reporting is problematic. We undertook a solutions-focused exercise to identify reporting barriers and devise a pilot improvement intervention.
Methods: We convened a multidisciplinary group of community-based oncologists, tumor registry (TR) staff, and hospital leadership. The group identified three key barriers to reporting: (1) inability to identify correct managing physician, (2) poor communication, and (3) manual reporting burden. Our intervention addressed the first two barriers and involved correcting physician contact information, simplifying contact forms, ascertaining cases in real time, and priming physician office staff to respond to TR requests.
Results: Preintervention, the TR did not identify any pilot patients' managing medical oncologists and little adjuvant treatment. During the April-May 2012 intervention, 22 patients with breast cancer listed our volunteer surgeon as managing physician. The TR sent 22 treatment letters to the surgeon's office and received 19 (86%) responses identifying the managing medical oncologist. Nine of the 19 cases (47%) were closed. To close a case required an average of 5.9 contacts and 28 minutes for electronic medical record-based cases and 38.9 minutes for community oncology cases. Sixty-four percent of required treatment was reported. Surgical staff spent ~0.5 hours per case to identify the oncologist prescribing adjuvant treatment.
Conclusion: The solutions-focused exercise improved identification of managing oncologists from 0% to 86% for patients treated by community oncologists. Treatment reporting increased from 2.6% to 64%. The pilot did not address the burden of reporting, which remains great. Electronic records can reduce this burden, but this approach is not currently feasible for many oncologists.