Aim
Direct Access Colonoscopy (DAC), a nurse-led telephone triage model, commenced statewide implementation through NSW Health’s Leading Better Value Care program. For patients with colorectal cancer access to diagnostic procedures are closely tied to equitable outcome. The wait time for diagnostic colonoscopy may impact stage at diagnosis and therefore the likelihood of treatment success. DAC improves access to timely colonoscopy for people with a positive bowel cancer screening test. It replaces the outpatient pathway with a streamlined, centralised referral and a direct booking for a colonoscopy where clinically appropriate.
Methods
The Cancer Institute NSW supported the rollout of DAC. This included synthesising data to advocate for Leading Better Value Care; the formation of a Clinical Advisory Group to develop the model of care, an evaluation framework, peer mentoring and a DAC Community of Practice; as well as baseline data collection, PREMs, clinician interviews and surveys, and data linkage for evaluation purposes.
Result
DAC reduced median wait times by 12 days compared to the outpatient pathway (82 vs 95 days), improved patient-reported experiences (76% reported appropriate wait vs 63% in 2020) and reduced barriers to access. Patients experienced cost savings (≥$65) while clinicians reported the ability to focus on complex cases. Economic modelling projected long-term savings of $46/patient over 10-years, and reduced carbon emissions by 4kg/patient.
Conclusion
DAC exemplifies value-based healthcare by improving access, patient and clinician experiences and system efficiency, while identifying opportunities to address equity.