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Yale Cancer Center Study Shows Benefits of a Next Day Access Program for Patients with Cancer

Friday, September 24, 2021

New Haven, CT — A pilot program developed by researchers at Yale Cancer Center offering next day access (NDA) for oncologic consultation for patients showed reduced wait times for initial access to cancer care and increased patient satisfaction, according to a new report. Study data will be presented on September 24, 2021 at the annual American Society of Clinical Oncology (ASCO) Quality Care Symposium.
“Delays in access to treatment have been shown to cause anxiety and distress in patients with cancer and even more troublesome, worse outcomes,” said Sarah Mougalian, MD, Associate Professor of Medicine (Medical Oncology) and Deputy Chief Ambulatory Officer at Smilow Cancer Hospital and Yale Cancer Center and lead author of the study. “It is critical to implement interventions that enhance navigation, improve access to cancer care, and eliminate operational and cultural barriers to prompt establishment of care and subsequent treatment initiation.”
The NDA program developed by Mougalian and colleagues offered oncologic consultation within 1 business day in two subspecialty clinics and two Smilow Cancer Hospital Care Center Network sites. Each pilot team created an implementation plan for breast and gynecological cancer patients, with algorithms defining patients “eligible” for NDA. Patients seen via NDA completed a brief anonymous survey regarding their experience.
In seven months, a total of 3107 new patients were seen across the 4 pilot sites, 900 (29.8%) of whom met “next day appropriate” criteria, and 370 (12%) of whom were seen via NDA. Patient satisfaction was extremely high, with 96% indicating that expectations were met or exceeded. Over half (56%) responded that a timely appointment was important when choosing  cancer care. The most common reasons patients were not seen via NDA included: specific provider requested (41%), specific date requested (23%), unavailable next day appointment (6%). Cultural barriers, particularly from treating physicians, included feeling that NDA appointments were inefficient with incomplete data, less time for clinical review, and increased burden due to last minute new patients; operational challenges included insufficient staffing and ensuring complete/accurate data collection. From December 2019 through February 2020, median time to first visit ranged from 17 to 36 days; median time to first visit decreased in 3 of the 4 pilot sites to 6-20 days 1 year later. 
“Success of this pilot required extensive effort to address change management and perceived barriers, but the results are very encouraging,” said Mougalian. “Deployment in other disease teams and at additional community sites is underway.”
Other Yale authors involved in the study include: Lisa Shomsky, MBA, BSN, CNML, Maureen Major Campos, RN, MS, and Anne C. Chiang, MD, PhD.

Smilow Cancer Hospital at Yale New Haven is part of the nationally recognized Yale New Haven Hospital, and is affiliated with Yale Cancer Center (YCC), one of only 56 National Cancer Institute (NCI)-designated comprehensive cancer centers in the nation and the only such center in Connecticut. Smilow Cancer Hospital, the most comprehensive cancer facility in New England, includes private inpatient rooms, multidisciplinary outpatient treatment centers, 12 operating rooms, infusion suites, diagnostic imaging services, and specialized women's and children’s services. Smilow Cancer Hospital also operates a dozen outpatient care centers across Connecticut. YCC and Smilow Cancer Hospital are members of the National Comprehensive Cancer Network (NCCN), an alliance of 28 cancer centers in the U.S., whose mission is to improve the quality, effectiveness and efficiency of oncology care.