Quality of diagnostic services for cancer: a comparison of open access and conventional outpatient clinics.
OBJECTIVE
To assess quality of a quick and early diagnosis route (QED) by determining effectiveness and cost-effectiveness of five clinics compared with three conventional outpatient clinics. Prospective economic evaluation. Six-month cohort of all referrals (November 1996-April 1997).


METHODS
All referrals for suspected cancers of: upper gastro-intestinal tract; urinary tract, prostate and testis; skin.


RESULTS
Median days saved between GP referral and date of: diagnostic appointment; consultant decision; intervention.


RESULTS
GP referral to diagnostic appointment: QED was effective (median days) for all clinics. Diagnostic appointment to consultant decision: QED was effective for testicular and haematuria clinics. Consultant decision to intervention: QED was effective for haematuria, testicular and melanoma clinics.
Extra (incremental) NHS cost per patient diagnosed.


RESULTS
Less than 5 Pounds per day saved between GP referral and diagnostic appointment for: endoscopy; haematuria; prostate; testicular; melanoma. Less than 3 Pounds per day saved between GP referral and consultant decision for: testicular; haematuria. Less than 3 Pounds per day saved between GP referral and intervention for: endoscopy; haematuria; testicular; melanoma.


CONCLUSIONS
A "quick and early" diagnostic route provides a higher quality service through improved effectiveness and cost-effectiveness compared to conventional outpatients.
Davies
C
C
Centre for Health Services Studies (CHESS), University of Warwick, Coventry, UK.
Grimshaw
G
G
Kendall
M
M
Szczepura
A
A
Griffin
C
C
Toescu
V
V
D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D006297:Health Services Accessibility; D006785:Hospitals, University; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000592:standards; D009369:Neoplasms / Q000175:diagnosis*; D016522:Oncology Service, Hospital / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D011787:Quality of Health Care; D012017:Referral and Consultation; D013222:State Medicine / Q000458:organization & administration / Q000592:standards; D013997:Time Factors; D006113:United Kingdom