Cancer tracking system improves timeliness of liver cancer care at a Veterans Hospital: A comparison of cohorts before and after implementation of an automated care coordination tool.

IntroductionHepatocellular carcinoma (HCC) requires complex care coordination. Patient safety may be compromised with untimely follow-up of abnormal liver imaging. This study evaluated whether an electronic case-finding and tracking system improved timeliness of HCC care.MethodsAn electronic medical record-linked abnormal imaging identification and tracking system was implemented at a Veterans Affairs Hospital. This system reviews all liver radiology reports, generates a queue of abnormal cases for review, and maintains a queue of cancer care events with due dates and automated reminders. This is a pre-/post-intervention cohort study to evaluate whether implementation of this tracking system reduced time between HCC diagnosis and treatment and time between first liver image suspicious for HCC, specialty care, diagnosis, and treatment at a Veterans Hospital. Patients diagnosed with HCC in the 37 months before tracking system implementation were compared to patients diagnosed with HCC in the 71 months after its implementation. Linear regression was used to calculate mean change in relevant intervals of care adjusted for age, race, ethnicity, BCLC stage, and indication for first suspicious image.ResultsThere were 60 patients pre-intervention and 127 post-intervention. In the post-intervention group, adjusted mean time from diagnosis to treatment was 36 days shorter (p = 0.007), time from imaging to diagnosis 51 days shorter (p = 0.21), and time from imaging to treatment 87 days shorter (p = 0.05). Patients whose imaging was performed for HCC screening had the greatest improvement in time from diagnosis to treatment (63 days, p = 0.02) and from first suspicious image to treatment (179 days, p = 0.03). The post-intervention group also had a greater proportion of HCC diagnosed at earlier BCLC stages (pConclusionsThe tracking system improved timeliness of HCC diagnosis and treatment and may be useful for improving HCC care delivery, including in health systems already implementing HCC screening

Cancer tracking system improves timeliness of liver cancer care at a Veterans Hospital: A comparison of cohorts before and after implementation of an automated care coordination tool

Introduction Hepatocellular carcinoma (HCC) requires complex care coordination. Patient safety may be compromised with untimely follow-up of abnormal liver imaging. This study evaluated whether an electronic case-finding and tracking system improved timeliness of HCC care. Methods An electronic medical record-linked abnormal imaging identification and tracking system was implemented at a Veterans Affairs Hospital. This system reviews all liver radiology reports, generates a queue of abnormal cases for review, and maintains a queue of cancer care events with due dates and automated reminders. This is a pre-/post-intervention cohort study to evaluate whether implementation of this tracking system reduced time between HCC diagnosis and treatment and time between first liver image suspicious for HCC, specialty care, diagnosis, and treatment at a Veterans Hospital. Patients diagnosed with HCC in the 37 months before tracking system implementation were compared to patients diagnosed with HCC in the 71 months after its implementation. Linear regression was used to calculate mean change in relevant intervals of care adjusted for age, race, ethnicity, BCLC stage, and indication for first suspicious image. Results There were 60 patients pre-intervention and 127 post-intervention. In the post-intervention group, adjusted mean time from diagnosis to treatment was 36 days shorter (p = 0.007), time from imaging to diagnosis 51 days shorter (p = 0.21), and time from imaging to treatment 87 days shorter (p = 0.05). Patients whose imaging was performed for HCC screening had the greatest improvement in time from diagnosis to treatment (63 days, p = 0.02) and from first suspicious image to treatment (179 days, p = 0.03). The post-intervention group also had a greater proportion of HCC diagnosed at earlier BCLC stages (pConclusions The tracking system improved timeliness of HCC diagnosis and treatment and may be useful for improving HCC care delivery, including in health systems already implementing HCC screening. Author summary Liver cancer typically occurs in people with advanced scarring of the liver, a condition called cirrhosis. Survival in liver cancer depends on both the stage of cancer and the severity of pre-existing liver disease. Treatment requires coordination between multiple subspecialties: Hepatology, Oncology, Interventional Radiology, and Surgery. The most common causes of liver cirrhosis in the United States are hepatitis C virus and alcohol use, and patients with cirrhosis often face difficulties accessing timely care due to coexisting mental health conditions and health systems barriers. We implemented a web-based tracking system at the Veterans Affairs (VA) Connecticut Healthcare System that 1) automatically generates queues of abnormal imaging suspicious for liver cancer using diagnostic codes and natural language processing, and 2) maintains queues of tasks for follow up diagnostic testing and cancer treatment. We found implementation of this tracking system reduced time from first image suspicious for liver cancer to first cancer treatment. Advances in diagnostic technology and treatment options for liver cancer will benefit patients the most if patients are connected to appropriate specialty treatment in a timely manner, and our study demonstrates the potential of this practical intervention to systematically address gaps in care in an at-risk population

Activist Materialism

This paper explores a form of activism that operates with and within matter. For more than 150 years materialism has informed activist practice through materialist conceptions of history and modes of production. The paper discusses the ambivalences of these previous configurations of activism and materialism and explores possibilities for enacting activist interventions in conditions where politics is not only performed as a politics of history but as the fundamental capacity to remake and transform processes of matter and life. What is activism when politics is increasingly performed as a politics of matter? What is activism when it comes to a materialist understanding of matter itself