Background: There are various outcome measures to evaluate the quality of multidisciplinary care for breast cancer patients. The National Consortium of Breast Centers defines “quality” of breast cancer care as “accurate evaluation and appropriate services in a timely manner.”
Objectives: In a tertiary academic center, a diverse referral pattern possibly influences time to treatment. We choose to examine 2 outcome mea sures before the start of a nurse navigator: Time from initial diagnosis to first consultation and if the pretreatment consultation for those receiving neoadjuvant chemotherapy or hormonal therapy included all subspecialists.
Methods: Electronic medical records of female patients with breast cancer seen during January through June 2010 were reviewed. Patients with stage IV breast cancer were excluded.
Results: In total, 150 patients were divided into 4 categories: external pathology consult (B1), internally diagnosed with a primary care physician (PCP) at our institution (B2), evaluated by a surgical oncologist before the biopsy (B3), and internally diagnosed with PCP outside of the institution (B4). For B2, B3, and B4, we examined the time intervals to first surgical oncology appointment after diagnosis as shown in the Table. For all patients (n = 10) who received neoadjuvant therapy, 1 patient saw a surgical oncologist, medical oncologist, and radiation oncologist; 9 patients saw 2 subspecialties prior to initiation of first treatment.
Conclusions: Patients are seen within an average of 2 weeks whether they are diagnosed internally (B2, B3) or externally (B4). The group seen by a surgical oncologist prior to biopsy (B3) was seen sooner. For the patients receiving neoadjuvant therapy, 10% saw all 3 specialties prior to initiation of therapy. In July 2010, a nurse navigator was added to the care team. With this new position, our goal is to decrease the time from biopsy to visit by 33% and have 100% of patients receiving neoadjuvant therapy evaluated by all 3 specialists prior to treatment. In addition, in January 2011, we implemented an e-mail–based patient satisfaction survey that is sent to all patients with whom the nurse navigator interacts. One of the questions on the survey asks for patients to rate timeliness of their care and ability to obtain appointments as soon as they wanted. Results from the first 3 months of 2011 show that patients rate their satisfaction in these 2 areas as either “satisfied” or “extremely satisfied.” Our intent is to quantify the effect of a nurse navigator in a large academic center as a quality metric in improving care.
