title: Timeliness across the continuum of care in veterans with lung cancer.
abstract: BACKGROUND
  By providing timely care at all steps along the continuum of lung cancer care, providers may be able to limit disease progression before treatment and possibly improve clinical outcomes. This study examines the timeliness of key events in the process of care between initial radiograph and first treatment.
  
  
  METHODS
  Dates of key events were extracted from the medical records of 2463 veterans receiving lung cancer care at 133 Department of Veterans Affairs (VA) facilities. After reviewing their site's abstraction results, facility leaders completed a survey on their perceptions of their local processes of lung cancer care.
  
  
  RESULTS
  Median time from first radiography to first treatment was 71 days. The longest intermediate time interval examined was between first treatment referral and first treatment (median = 12 days). Time from first to last diagnostic test was most variable (interquartile range = 0-27 days). We found a significant trend indicating that the time interval from first radiograph to treatment was shorter for patients with more advanced disease. This effect was also significant within six of the seven intermediate time intervals we examined. Survey responses indicated that the chart review process stimulated improvement activity.
  
  
  CONCLUSIONS
  Although patients with earlier stage disease benefit more from treatment, they do not proceed as quickly through the continuum of care as patients with more advanced disease. By measuring variability in timeliness of care at multiple steps in the lung cancer care process, facilities may identify opportunities for improvement.
authors.affiliation: Center for Chronic Disease Outcomes Research (CCDOR), VA Medical Center, Minneapolis; daggerCenter for Primary Care and Outcomes Research, Stanford University, California, USA. adam.powell@va.gov
authors.forename: Adam A
authors.initials: AA
authors.lastname: Powell
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Schultz
authors.forename: Diana L
authors.initials: DL
authors.lastname: Ordin
authors.forename: Mark A
authors.initials: MA
authors.lastname: Enderle
authors.forename: Barry A
authors.initials: BA
authors.lastname: Graham
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Partin
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gould