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A New Method for Analyzing Diagnostic Delay in Gynecological Cancer
  1. Mai Partridge Vandborg, MD*,,
  2. Kasper Edwards, PhD,
  3. Jakob Kragstrup, DMedSci,
  4. Peter Vedsted, PhD§,
  5. Dorte Gilså Hansen, PhD and
  6. Ole Mogensen, DmedSci*
  1. *Department of Gynecology and Obstetrics, Odense University Hospital,
  2. Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense C;
  3. Department of Management Engineering, Technical University of Denmark, Kongens Lyngby;
  4. §Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Aarhus University, Aarhus C; and
  5. National Research Center of Cancer Rehabilitation, Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense C, Denmark.
  1. Address correspondence and reprint requests to Mai Partridge Vandborg, MD, Department of Gynecology and Obstetrics, Odense University Hospital, University of Southern Denmark, Sdr. Boulevard 29, DK-5000 Odense C, Denmark. E-mail: mvandborg@health.sdu.dk.

Abstract

Objective The aim of this article is to present a new methodology to illustrate, understand, and measure delay in health care. The method is inspired by process mapping tools as analytical framework and demonstrates its usefulness for studying diagnostic delay in gynecological cancer.

Materials and Methods Six women with a diagnostic delay of 6 weeks or more before treatment of gynecological cancer at a specialized regional department (the Department of Gynecology and Obstetrics, Odense University Hospital, Denmark) were included in the study. Maps of existing processes were performed for each patient reflecting the patients’ pathway through the course of the disease. We combined 2 process mapping tools, namely, value stream mapping and business process modeling notation. The first method identifies the flow in a process as timelines. The latter introduces a set of easily recognizable graphical elements.

Results Detailed information concerning the cancer patients’ pathway was obtained. The method visualized the complexities within the diagnostic pathway. The role of different participants (patient, general practitioner, and local hospitals) became clear by arranging activities according to responsibilities and was shown to recurrently influence and contribute to the delay in the diagnostic process. Some important contributors to diagnostic delay in gynecological cancer, such as lack of cancer suspicion, competing diseases, negative test results, inexpedient referral patterns, and referrals without cancer suspicion, were found.

Conclusions Our results point out process mapping tools as a potential analytical framework to illustrate, understand, and measure delay in health care. Furthermore, the method was able to identify important contributors to the diagnostic delay in gynecological cancer patients.

  • Process mapping
  • Diagnostic delay
  • Gynecological cancer

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Footnotes

  • This study was supported by the Novo Nordic Foundation and the Ministry of Interior and Health, Denmark.

  • The authors have stated explicitly that there are no conflicts of interest in connection with this article.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.ijgc.net).

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