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Kaiser Permanente Georgia: Colon cancer care through the science of performance improvement.

250 Background: While our patients reported high satisfaction with the care they received, Kaiser Permanente Georgia's baseline assessment found variation in the way our colon cancer patients were diagnosed and received care. This variation also effects the cycle time from diagnosis to initiation of treatment (surgery or first infusion).

METHODS: Using Kaiser Permanente's Performance Improvement methodology and interdisciplinary cooperation, this project launched in January of 2014. A multidisciplinary team representing the GI, Surgery, Oncology, Nursing, Radiology, Palliative Care and Patient Safety departments, was formed and facilitated by a PI specialist to examine the different workflows. The team performed an in-depth baseline analysis of the current state, including patient interviews and surveys. At the completion of the baseline analysis all clinical departments came to an agreement for future state process design. In addition to developing workflows, an order bundle was developed to bridge the gap between the baseline and future states. The improvements were tested and both qualitative and quantitative feedback was collected on effectiveness of the changes.

RESULTS: This project resulted in an agreed upon standardized nursing and provider workflow and identified a diagnostic bundle to be carried out on the day of colonoscopy for treating suspected CRC patients. These improvements resulted in a reduction to the average time from diagnosis to treatment for Colorectal Cancer patients by 40.3%. The variation in time from diagnosis to treatment was reduced by 60.5%.

CONCLUSIONS: We are pleased these positive results improve on the cancer care we provide to our patients. Multidisciplinary communications and agreements were key to the success of this project. Our next steps involve migrating the CRC diagnostic bundle into KPs EMR, developing a reliable surveillance follow-up method, and further reducing the time to treatment by focusing on the surgical pathway.

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