The Diagnostic Assessment Program

The Diagnostic Assessment
Program
Dr. Craig McFadyen, BSc(Hons), MD, MHCM, FRCS(C)
Regional Vice President, Cancer Care Ontario for the
Mississauga Halton/Central West Regional Cancer Program
Chief & Medical Director, Oncology, Trillium Health Partners
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Faculty/Presenter Disclosure
Faculty:
Dr. Craig McFadyen, MD, Regional Vice President,
Mississauga Halton/Central West Regional Cancer
Program: “Primary Care Oncology Day”
Relationship with Commercial Interests:
Not applicable.
No affiliation (financial or otherwise) with a
pharmaceutical, research, medical device,
consulting or other communications organization
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Diagnostic Assessment Program (DAP)
Overview
WHAT IS A DAP?
Diagnostic Assessment Programs (DAPs) are designed to improve the experience of patients with
suspected cancer as they go through the diagnosis process.
These programs are made up of multi-disciplinary healthcare teams that manage and coordinate a
patient’s diagnostic care from testing to a definitive diagnosis, leading to improved access to
care.
DAPs also provide the necessary support and information about cancer to patients and their
families
THE DAP PROGRAM AT CCO HAS THREE OBJECTIVES:
Decrease time from
suspicion to diagnosis
or resolution
Improving patient
outcomes where possible
Optimize the patient
experience during the
diagnostic process
Improving integration of care
among providers
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Why are DAPs a Good Thing?
Because the system caters to the health care
provider, not the patient.
We cling to an old paradigm of diagnosis and
treatment which forces patients into multiple,
sequential lines invariably delaying diagnosis ( or
resolution) and increasing emotional stress.
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The System should submit to
The Patient, and not vice versa.
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DAP Goals
• Improve coordination of care
• Decrease wait time
• Optimize the patient and healthcare provider
experience
• Minimize disease progression where possible
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• Streamlined diagnostic scheduling and
coordination of testing
• Relevant and timely information and support for
patients throughout the process
• A single point of access for all diagnostic services
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• BREAST
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Mississauga Halton
2011
2012
AVE
WORST
BEST
TARGET
Central West
2011
2012
AVE
WORST
BEST
TARGET
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Breast: Referral to Consult
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Breast: Referral to Diagnosis
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• LUNG
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Lung Diagnostic Pathway: Part 1
Lung Diagnostic Pathway: Part 2
Lung Diagnostic Pathway: Part 3
Lung: Referral to Nurse Navigator
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Lung: Referral to Consult
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Lung: Referral to Diagnosis
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• PROSTATE
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Prostate Diagnostic Pathway: Part 1
Prostate Diagnostic Pathway: Part 2
Prostate: Referral to Consult
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• The Nurse Navigator is critically
important
• Speed is not the only thing
patients are looking for
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What is still missing?
Patients are stressed and anxious when waiting for a diagnosis. Emotional
support during this time is low – WE NEED TO DO BETTER… HOW?
Patient
Navigation
Diagnostic
Wait
Times
DAP-EPS
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Nurse Navigator
• Must be knowledgeable about the disease site
and all phases of the diagnostic & treatment
journey
• Investing in a comprehensive education pays
huge dividends
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Nurse Navigator
Breast:
Referral
Consult and biopsy
Rx
Nurse Navigator
Lung:
Referral
Consult
Biopsy
Rx
Nurse Navigator
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5/12/2014
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3
Cance
r
Patient Experience with
Nurse Navigator
Over 95 percent of patients scored their overall experience with the
nurse navigator “very satisfactory” or “satisfactory”.
Patient Experience Surveys
Data range: October 1, 2011 – March 31, 2012
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Do DAPs Improve Outcomes?
 Advanced the use of sentinel LN biopsy (breast cancer) and
neoadjuvant treatment (locally advanced breast cancer and
rectal cancer)
 Improved concordance with clinical practice guidelines
 Improved inter-professional relationships
 Improved in-hospital experience
 Improved post op consultation interaction
 Reduction in peri-operative mortality for lung lobectomy
 Better utilization of Multidisciplinary Case Conferences
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