Patient-centered wait time measurement in Ontario.
Bibliographic record
Abstract
233 Background: Since 2005, a concerted effort to measure and manage access to chemotherapy services in Ontario has resulted in a significant reduction in several specific wait time intervals (referral for medical oncology consultation and medical oncology consultation to first treatment). To identify other opportunities to improve access, a comprehensive analysis of the all-inclusive wait times from cancer diagnosis to the start of adjuvant chemotherapy for patients with early stage colon, breast, and lung cancer (patient centered wait time) has been undertaken. Methods: The study cohort comprised all Ontario patients who received adjuvant chemotherapy in 2009 for early stage colon, breast, and lung cancers. The Ontario Cancer Registry, linked to several administrative healthcare databases in Ontario, was used to identify the cohort and variables of interest. Wait time from diagnosis of cancer to the initiation of adjuvant chemotherapy was measured and separated into segments based on the dates of diagnosis (D), surgery (S), referral to medical oncology (R), medical oncology consultation (C), and first adjuvant chemotherapy treatment (T), and each was analyzed for variation at a regional and institutional level. The times from surgery to pathology sign-out (TTPR) and for peripherally inserted central catheter (PICC) acquisition were also studied in a subset of cases. Results: In 2009, 86% of patients with stage III colon cancer, 80% of patients with stage I to III breast cancer and 63% of patients with stage II lung cancer who received adjuvant chemotherapy started their treatment within 120 days of diagnosis. There was significantly better performance and less regional variation for colon cancer patients (82-93%) than for breast cancer patients (63-90%). For the whole cohort of breast cancer patients, the median total time from diagnosis to adjuvant chemotherapy was 81 days with the following segmental breakdown D-S (30 days), S-R (19 days), R-C (16 days), and C-T (16 days). The mean TTPR for colon cancer patients was 11.6 days and PICC insertion was < 7 days in 92% of patients. Conclusions: A number of opportunities for process improvement were identified, including shortening the pathology reporting interval and the timing for initiating referral to a medical oncologist.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".