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This study defines emergency presentation (EP) as a new cancer diagnosis within 30 days after an emergency department or inpatient stay, builds a digital quality measure (dQM) for EP in lung and colorectal cancers using electronic health records from two systems (2016–2020), validates measure accuracy via chart review, and quantifies how EP relates to missed opportunities for diagnosis (MODs) and subsequent mortality. Logistic regression using longitudinal encounter and mortality data estimates adjusted 1-year mortality associations.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/research-report/","Research & 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is emergency presentation (EP) defined in this study?","Question",{"text":63,"@type":64},"EP is defined as a new cancer diagnosis within 30 days after an emergency department or inpatient visit.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What data sources and cancers were used to develop the digital quality measure (dQM)?",{"text":68,"@type":64},"EPs for lung cancer and colorectal cancer were identified using electronic health record databases from two health systems: the Department of Veterans Affairs and Geisinger, covering 2016–2020.",{"name":70,"@type":61,"acceptedAnswer":71},"What relationship did EP show with missed opportunities for diagnosis (MODs) and mortality?",{"text":72,"@type":64},"Chart review indicated that MODs represented a substantial portion of EP cases, and EP was associated with significantly higher odds of 1-year mortality for both lung cancer and colorectal cancer after adjustment for cancer stage and 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Digital Quality Measure of Emergency Cancer Diagnosis  \nPaarth Kapadia, MD1,2; Andrew J. Zimolzak, MD, MMSc1,2 ; Divvy K. Upadhyay, MD, MPH3 ; Saritha Korukonda, MD, MS3; Riyaa Murugaesh Rekha, MBBS3; Umair Mushtaq, MBBS, MS1,2; Usman Mir, MBBS, MPH1,2 ; Daniel R. Murphy, MD, MBA1,2  ; Alexis Offner, MPH1,2 ; Gary A. Abel, PhD, MSc4 ; Georgios Lyratzopoulos, MD, MPH5 ; Luke T.A. Mounce, PhD, MSc4 ; and Hardeep Singh, MD, MPH1,2   \nDOI [https://doi.org/10.1200/JCO.23.01523](https://doi.org/10.1200/JCO.23.01523)  \n\n| ABSTRACT |  |\n| --- | --- |\n| PURPOSE | Missed and delayed cancer diagnoses are common, harmful, and often preventable. Automated measures of quality of cancer diagnosis are lacking but could identify gaps and guide interventions. We developed and implemented a digital quality measure (dQM) of cancer emergency presentation (EP) using electronic health record databases of two health systems and characterized the measure’s association with missed opportunities for diagnosis (MODs) and mortality. |\n| METHODS | On the basis of literature and expert input, we defined EP as a new cancer diagnosis within 30 days after emergency department or inpatient visit. Weidentified EPs for lung cancer and colorectal cancer (CRC) in the Department of Veterans Affairs (VA) and Geisinger from 2016 to 2020 . We validated measure accuracy and identified preceding MODs through standardized chart review of 100 records per cancer per health system. Using VA’s longitudinal encounter and mortality data, we applied logistic regression to assess EP’s association with 1-year mortality, adjusting for cancer stage and demographics. |\n| RESULTS | Among 38,565 and 2,914 patients with lung cancer and 14,674 and 1,649 patients with CRCs at VA and Geisinger, respectively, our dQM identified EPs in 20.9% and 9.4% of lung cancers, and 22.4% and 7.5% of CRCs. Chart reviews revealed high positive predictive values for EPs across sites and cancer types (72%-90%), and a substantial percent represented MODs (48.8%-84.9%) . EP was associated with significantly higher odds of 1-year mortality for lung cancer and CRC (adjusted odds ratio, 1.78 and 1.83, respectively, 95% CI, 1.63 to 1.86 and 1.61 to 2.07) . |\n| CONCLUSION | AdQM for cancer EP was strongly associated with both mortality and MODs. The findings suggest a promising automated approach to measuring quality of cancer diagnosis in US health systems. |\n\nACCOMPANYING CONTENT  \n Editorial, p. 2491  Data Supplement  \nAccepted February 16, 2024 Published May 8, 2024  \nJ Clin Oncol 42:2506-2515 Published by American Society of Clinical Oncology  \nView Online Article  \nCreative Commons Attribution Non-Commercial No Derivatives 4.0 License  \nINTRODUCTION  \nMissed and delayed cancer diagnosis is common, affecting over one third of patients with colorectal or lung cancer.1 ,2 Delayed cancer diagnosis is often preventable and is a leading cause of harm in US malpractice claims.3,4 Prolonged diagnostic intervals and treatment delays often arise from missed opportunities to initiate or complete appropriate diagnostic investigation.1 ,2 These missed opportunities for diagnosis (MODs) commonly result from diagnostic process breakdowns, for example, missed test results, lost patient referrals, and clinician-patient miscommunication.  \nIn 2015, the National Academy of Medicine called for approaches to identify and mitigate MODs.5 More recently, the  \nCenters for Medicare & Medicaid Services (CMS) emphasized digital quality measures (dQMs) that evaluate longitudinal electronic health record (EHR) data across multiple care settings to address measurement gaps in quality.6 However, no dQMsin the United States assess cancer diagnostic quality from the perspective of MODs. MODs remain difficult to measure and often require labor-intensive chart reviews to detect.5 Cancer-related dQMs could help quantify diagnostic quality, identify areas for improv","cbCait0865b70MjA","https://ap.wps.com/l/cbCait0865b70MjA","pdf",632424,11,"English","# Abstract\n## Purpose\n## Methods\n## Results\n## Conclusion\n# Introduction\n## Diagnostic delays and missed opportunities\n## Digital quality measures and measurement gaps\n## Routes to Diagnosis context and EP definition\n# Context\n## Key Objective\n## Knowledge Generated\n## Relevance","[{\"question\":\"How is emergency presentation (EP) defined in this study?\",\"answer\":\"EP is defined as a new cancer diagnosis within 30 days after an emergency department or inpatient visit.\"},{\"question\":\"What data sources and cancers were used to develop the digital quality measure (dQM)?\",\"answer\":\"EPs for lung cancer and colorectal cancer were identified using electronic health record databases from two health systems: the Department of Veterans Affairs and Geisinger, covering 2016–2020.\"},{\"question\":\"What relationship did EP show with missed opportunities for diagnosis (MODs) and mortality?\",\"answer\":\"Chart review indicated that MODs represented a substantial portion of EP cases, and EP was associated with significantly higher odds of 1-year mortality for both lung cancer and colorectal cancer after adjustment for cancer stage and demographics.\"}]","Development and Implementation of a Digital Quality Measure of Emergency Cancer Diagnosis - Abstract Summary - Association with MODs and Mortality | PDF",1790002999,28]