Diagnostic Delay Time (DDT) and Integrated Diagnostics

One component of Diagnostic Adverse Events (see: New Attention Being Directed toward Diagnostic Adverse Events (DAEs)) is the Diagnostic Delay Time (DDT). I discussed the topic of diagnostic delays in a recent note, comparing them to Clinical Adverse Events (CAEs) (see: Breast cancer diagnostic delay depends more on race than insurance). Below is an excerpt from the DDT article as it relates to breast cancer:

Race and ethnicity appeared to affect diagnostic delay more than insurance status for women with breast abnormalities, as revealed by data presented at [a recent conference].... Findings revealed that non-Hispanic black and Hispanic women with government or private insurance waited more than twice as long for a definitive diagnosis than non-Hispanic white women with government or private insurance. Diagnostic delay time, or the amount of time between when abnormalities were found until a diagnosis was reached, for uninsured black women was more than twice as long as that of black women with private insurance. Although having private insurance reduced time to diagnosis for black women, they still waited significantly longer for a diagnosis than white women with private insurance....Among those with private insurance, diagnostic delay time, or the number of days from abnormal screening to definitive diagnosis, was 15.9 days for white women, 27.1 days for black women and 51.4 days for Hispanic women. Diagnostic delay times among those with government insurance were 11.9 days for white women, 39.4 days for black women and 70.8 days for Hispanic women. Finally, among those without insurance, diagnostic delay times were reported as 44.5 days for white women, 59.7 days for black women and 66.5 days for Hispanic women.

It's relatively easy to criticize the definition for Diagnostic Delay Time (DDT) in the article cited above: the amount of time between when abnormalities were found until a diagnosis was reached. It is somewhat vague because there are a number of techniques necessary to reach a diagnosis of breast cancer. DDT is then a time measurement that is the sum of all of them. However, it's a good place to start. Let's assume that the "diagnostic cascade" culminating in the diagnosis of breast cancer for a patient starts in most cases, with the palpation of a patent's breast mass or the identification of a breast abnormality during screening mammography. Obviously, most such lesions are confirmed by cytopathology or histopathology by a pathologist. We know from the above cited research that this chain of events takes between two weeks and two plus months. I probably would have guessed that this was the time required even before I read this article.

For cases at the high end of this range of times, I am sure that there are a number of causes such as overworked personnel, long queues of patients, and the use of older technology in under-funded public hospitals. In a number of previous notes and to help address this delay, I have recommended integrated diagnostics whereby pathology, lab medicine, and radiology personnel collaborate more closely. Simply put, the goal of this integration is to achieve faster, better, and cheaper diagnostic care.

For me, there are two key ingredients to achieve faster, definitive diagnoses of breast lesions, which is to say reducing the DDT. They are increased efficiency of diagnostic scheduling and parallel processing. I believe that both of these goals can be achieved by the development of integrated diagnostic centers (see: Plan for the Evolution of Integrated Diagnostic Centers Beyond Breast Clinics). These can be either physical or virtual "centers" in which the diagnostic information systems (LISs, RISs, PACSs) can be programmed to schedule all tests and procedures with the goal of the elimination of "down-time" from the process. This scheduling will be accomplished by the use of work-flow computer algorithms that take into account both positive and negative results as they become available in the systems. In this way, I believe that it will be possible to achieve an average three-day diagnostic turn-around time (D-TAT) for most patients with suspicious breast lesions.

Comments

[Delayed Diagnosis]

When you or a family member has an illness that has been exacerbated by delayed diagnosis, in order to make a delayed diagnosis compensation claim you have to show that the delay in the diagnosis was unreasonable and could have been avoided. Your physician, or the hospital or health centre in which she works, may claim that there were circumstances preventing an earlier accurate diagnosi

[Penegra]

This is ridiculous..!! Health care professionals must stress follow-up with all non-Hispanic black and Hispanic women with breast abnormalities to assure they are diagnosed as soon as possible..