Improving access and timeliness of care for veterans with head and neck squamous cell carcinoma: A multidisciplinary team's approach.
OBJECTIVE
With the prevalence of head and neck squamous cell carcinoma (HNSCC) nearly twice as high in veterans (6%) than general populations (3%), the noted problems of long waits and access to care in United States Veterans Affairs (VA) hospitals across the country are pressing. We examined primary outcome measures of timeliness and access to care for our patients with HNSCC assessing a multidisciplinary team approach at our VA hospital.


METHODS
Retrospective chart review.


METHODS
Our patients newly diagnosed with HNSCC were identified from two 24-month periods: diagnosis before (group 1, 2005-2006) and after (group 2, 2008-2009) implementing our multidisciplinary team in 2007. No significant differences in age (P = .13) or disease stage (P = .18) occurred between groups. Primary and secondary outcomes (i.e., treatment modality, imaging, completion of treatment, survival) were compared.


RESULTS
Timeliness to care improved for all measures. Improvement was significant for times from consult placed to seen in clinic (27.5-16.5 days; P < 0.0001) and from positive biopsy reported to date of initiating definitive treatment (35-27 days; P = 0.04). Pretreatment consults to various services represented by the multidisciplinary team increased from one to four (P < 0.0001). Two-year mortality was approximately the same between group 1 (33%) and group 2 (36%) (P = 0.035). Five-year mortality was slightly better in group 2 (50%) versus group 1 (61%), although not statistically significant.


CONCLUSIONS
Our veteran population with HNSCC had improved timeliness and access to care with our multidisciplinary approach.


METHODS
4. Laryngoscope, 126:627-631, 2016.
Department of Otolaryngology Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, U.S.A.|Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A.|Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, Ohio, U.S.A.
Reena Dhanda
RD
Patil
Department of Otolaryngology Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, U.S.A.
Jareen K
JK
Meinzen-Derr
Department of Otolaryngology Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, U.S.A.|Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, Ohio, U.S.A.
Brian L
BL
Hendricks
Department of Otolaryngology Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, U.S.A.|Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, U.S.A.|Neurosensory Disorders Center at UC Neuroscience Institute, Cincinnati, Ohio, U.S.A.
Yash J
YJ
Patil
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010348:Patient Care Team / Q000458:organization & administration; D016016:Proportional Hazards Models; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*; D014850:Waiting Lists
Multidisciplinary care; head and neck cancer; outcomes; veterans