title: Timely access and quality of care in colorectal cancer: a population-based cohort study using administrative data.
abstract: BACKGROUND
  While efforts to improve cancer outcomes have typically focused on improving quality of care, recently, a growing emphasis has been placed on timely access to quality cancer care. This retrospective cohort study examines, at a population level, the relationship between quality and timeliness of colorectal cancer (CRC) care in a single Canadian province (Nova Scotia). Through the provincial cancer registry, we identified all residents diagnosed with invasive CRC between 2001 and 2005 that underwent a non-emergent resection. Using anonymized administrative databases that are individually linked at the patient level, we obtained clinicodemographic, diagnostic, and treatment event data. Selected charts were reviewed to ensure completeness of chemotherapy data. Performance on six quality indicators and the percentage of patients achieving wait-time benchmarks for diagnosis, surgery, and adjuvant therapy were calculated. The relationship between quality indicators and wait-time benchmarks was examined using logistic regression.
  
  
  RESULTS
  Where an association was identified, patients who received 'higher quality care' had longer wait times. Individuals who received a complete preoperative colonoscopy were less likely to meet benchmarks for time from presentation to diagnosis and from diagnosis to surgery. Those who received an appropriate radiation oncology consultation were less likely to meet benchmarks for time from diagnosis to surgery and from surgery to adjuvant therapy.
  
  
  CONCLUSIONS
  As governments and other organizations move forward with strategies to reduce wait times, they must also focus on how to define and monitor quality care, and consider the relationship between these two dimensions of health care. Similarly, when developing quality improvement initiatives, the impact on resource utilization and potential to create longer waits for care must be considered.
authors.affiliation: Cancer Outcomes Research Program, Cancer Care Nova Scotia, Halifax, Nova Scotia, Canada. Geoff.Porter@cdha.nshealth.ca.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Porter
authors.forename: Robin
authors.initials: R
authors.lastname: Urquhart
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kendell
authors.forename: Jingyu
authors.initials: J
authors.lastname: Bu
authors.forename: Yarrow
authors.initials: Y
authors.lastname: McConnell
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009674:Nova Scotia; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014850:Waiting Lists
chemical_list: D000970:Antineoplastic Agents