Models of Care Toolkit

Diagnostic pathways and rapid referral services

Rapid referral pathways streamline the pre-diagnosis process and improve the speed with which patients get accurate diagnoses and find cancers earlier.

Defining characteristics of a diagnostic pathway map

A – Provides a tailored snapshot of a patient’s unique care pathway.

B – Organizes information by cancer type and phase along the cancer journey

C – Designed as a tool for use by healthcare providers, administrators and people new to the cancer system.

D – Evidence-based from local, national and international clinical practice guidelines.

E – Responsive to new and rapidly evolving treatment or technology evidence.

clipart of a winding road

Connected care approach

A connected care approach can support and enhance the organization of patient care through patient access to information and navigation, effective communication and cooperation across healthcare providers, as well as timely delivery of services14.

Key enablers to implementing innovative models of care in the early diagnosis phase include:

  • Engagement of both cancer and primary care teams
  • Leadership buy-in
  • Creation of multidisciplinary teams
  • Involvement of patients in planning and decision making
  • A robust evaluation and sustainability plan.

The principles of equity-by-design, including goal clarity, a focus on equity-mindedness and continual learning, serve as core tenets of any major model implementation, especially those involving multiple care providers.15

Connected care approaches can also support primary care teams to play a critical role in diagnosis. Some primary care providers may face barriers such as a lack of knowledge or information to ensure patients have timely access to the right diagnostic tests16 and when to refer patients.

Although connected care models are shown to streamline the diagnosis process, the lack of patient access to primary care and the resulting reliance on walk-in clinics and emergency departments impact continuity of care and timely diagnosis.

Denmark’s three-legged referral strategy provides a roadmap for primary care teams that is based on a patient’s symptoms. Recognizing each patient will present differently along the disease trajectory, the referral strategy provides a clear pathway to assess symptoms.

The three-legged referral model supports:

  • Reduced wait times
  • Enhanced collaboration between primary health care and cancer care
  • A shift to earlier stages at diagnosis in some cancers and an increase in one-year survival rates
  • Enhanced satisfaction with quality of care and wait times among patients and staff

Patients with specific alarm symptoms represent approximately half of cases and have access to an urgent referral with a 2-week wait time for a specialist based on symptom criteria listed in pathway.

Patients with serious but unspecific symptoms represent approximately 20% of cases and have access to an urgent pathway. A family physician orders a standard battery of tests then either refers the patient to the specific urgent referral pathway or decides on further diagnostic testing.

Patients with vague and non-serious symptoms represent approximately 30% of patients. No-Yes-Clinics provide family physicians access to more detailed diagnostic investigations without referring the patient to a specialist.

Denmark model pathway

 

The Accelerated Diagnostic Assessment Program (ADAP) at Kingston Health Sciences Centre in Ontario reduces wait-times for patients needing diagnostic workup after imaging results where cancer is suspected.

The ADAP coordinates care from referral to diagnosis and treatment. Typical ADAP patients are referred by emergency departments or primary care providers and do not meet the criteria for existing referral pathways that include potential breast, prostate, gynecologic and lung cancers.

By providing a clear pathway for primary care providers and emergency departments to refer patients with suspected cancers, the ADAP significantly shortens time for patients from referral to tissue biopsy compared to a control group and provides patients with timely access to treatment that surpasses provincial and national guidelines.

Evaluating interventions

Planning for performance measurement and evaluation early in the implementation phase supports continuous quality improvement, monitoring and learning about what’s working and why (or why not).

Involve key stakeholders and community partners in evaluation planning and consider applying the CART Principles to ensure the approach is credible, actionable, responsible and transportable:

Image source: Goldilocks M&E project

If an intervention is designed to address the needs of First Nations, Inuit and Métis and/or underserved communities, the project team must work with members of these communities to determine appropriate measures to describe progress and learning about advancing equity in cancer care. When implementing models for First Nations, Inuit and Métis, engage communities in model development and ensure access to culturally-appropriate diagnostic care.

Equity-based outcome indicators are critical to measuring the impact and effectiveness of such initiatives. Learn more about equity-focused evaluation and performance measurement.

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