Abstract P3-10-10: Planning and implementation of two regional one-stop breast health centres within a large geographic health authority: Outcomes and quality improvements in health service delivery
Notice bibliographique
Résumé
Abstract Interrogative examination of wait times for the pathway steps leading to diagnosis, surgical treatment, and oncology consultation for breast cancer within a geographically dispersed publically funded health authority led to advocacy for and establishment of two large one-stop Breast Health Centres (BHCs) within the largest urban cities. One year after publication of the 2000 EUSOMA guidelines for breast cancer diagnosis and treatment, regional breast cancer pathways and wait times did not meet guidelines. Population median wait time from date of first investigation to tissue diagnosis was 2.7 or 5.9 weeks (for clinical presentation or screen presentation respectively), 6.0/7.0 weeks to definitive surgical intervention, and 14.3/11.7 weeks to oncology consultation. Only 39 % of patients were diagnosed initially via core needle biopsy. 5 % of patients underwent immediate reconstructive surgery. Due to wait times for initial imaging (mammogram, ultrasound) at hospital facilities, baseline imaging was often performed at private imaging labs without needle diagnostic capability, and repeated again with a series of wait times at the hospitals - as the initial community images were not accessible to the hospital interventional radiologists. Smaller communities and their hospitals maintained shorter wait times in comparison to the large urban centres. Repeat population based measurement in 2009 indicated wait times were unchanged, and MRI guided biopsy was still not available within the region. Nursing support and patient education re breast cancer prognosis and treatment was not available until the time of oncology consultation. BHCs were planned, funded by the Ministry of Health, established in physical conjunction with the breast screening programs, and became operational as of early 2012. During the first year of BHC operation, population median wait time from date of first investigation was 2.0 weeks for tissue diagnosis, 6.4 weeks for final definitive surgical intervention, and 9.4 weeks for oncology consultation. 90 % of patients were initially diagnosed via initial core needle biopsy with IHC staining for ER, PR, and HER2. Patients served by the BHCs had nurse navigator support and education from time of presentation. The surgical team overcame regional surgical wait time barriers such as available admission beds by establishing the first comprehensive population-based outpatient mastectomy and reconstruction program in Canada with over 1200 performed to date. These wait times have been maintained in spite of increase in the HA population from 1.2 million to 1.6 million during the project timeline. Citation Format: Martin LA, Janzen R, Wong F, Doris P. Planning and implementation of two regional one-stop breast health centres within a large geographic health authority: Outcomes and quality improvements in health service delivery [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-10-10.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,013 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,003 | 0,004 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».