eCQM: Rate of Delayed or Missed Follow-up on Abnormal Cancer Screening Tests in Primary Care

When cancer diagnostic testing is delayed, patients are at risk of the cancer progressing and being detected at a later stage requiring more aggressive treatments and associated with lower survival. A study evaluating follow up on abnormal prostate-specific antigen (PSA) test results reported that only 70% of men received either a repeat PSA test or prostate biopsy within nine months of the abnormal result. Schroder et al. found in one study that screening with PSA was associated with a 21% relative reduction in prostate cancer mortality over an 11-year follow up period. There is clearly a performance gap that needs to be addressed for the colorectal, breast and prostate cancer screening processes. We aim to improve diagnostic excellence in timely diagnosis of colorectal, breast and prostate cancers. The proposed electronic clinical quality measure (eCQM) will report the percentage of abnormal screening tests where diagnostic testing was delayed or missed according to established guidelines for follow up. The denominator includes all patients with at least one abnormal screening test result for colorectal, breast or prostate cancer during the measurement period where the requisition originated in primary care. The eCQM is patient based; only the first abnormal test in the measurement period is included. Denominator exclusions include patients with a previous colorectal, breast or prostate cancer diagnosis and those receiving hospice or palliative care. The numerator includes patients from the denominator where follow up with diagnostic testing was either delayed or missed. Time to follow up will be calculated as the number of days between documentation of the abnormal result in the EHR and the patient receiving the follow-up diagnostic testing. Whether or not follow up was delayed will be informed by a review of the published literature and international guidelines. To promote diversity, equity and inclusion, we will further test the proposed eCQM at UK Healthcare in Kentucky, which covers a more racially and geographically diverse (i.e., more rural) population, to allow for testing of the eCQM across different subgroups to ensure consistent performance.