Knowledge or noise? Making sense of General Practitioners’ and Consultant use of two-week-wait referrals for suspected cancer

Conan Donnelly, Nigel Hart, Alan David McCrorie, Lesley Anderson, Michael Donnelly, Peter Murchie, Anna Gavin

Research output: Contribution to journalArticle

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Abstract

Background: Early diagnosis and treatment of cancer is the goal of the 2-week-wait referral pathway (2WW). Variation exists between General Practice use of 2WW and rates of consultant reprioritisation of GP referral from routine to 2WW (Consultant Upgrade). We investigated variation in General Practice and Consultant Upgrade 2WW referral activity. Methods: Data from 185 000 referrals and 29 000 cancers recorded between 2011 and 2013 from the Northern Ireland Cancer Waiting Time database (CaPPS) were analysed to ascertain standardised referral rate ratios, detection rate (DR) (=sensitivity) and conversion rate (CR) (=positive predictive value) for Practice 2WW referrals and Consultant Upgrade 2WW. Metrics were compared using Spearman’s rank correlation co-efficients. Results: There was consistency in Practice and Consultant Upgrade 2WW referral rates over time, though not for annual DR (Spearman’s ρ<0.37) or CR (Spearman’s ρ<0.26). Practice 2WW referral rates correlated negatively with CR and positively with DR while correlations between DR and CR were restricted to single-year comparisons in Practice 2WW. In Consultant Upgrade, 2WW CR and DR were strongly correlated but only when the same cancers were included in both rates. Conclusions: Results suggest ‘random case mix’ explains previously reported associations between CR and DR with more ‘hard to detect’ cancers in some Practices than in others in a given year corresponding to lower DR and CR. Use of Practice and Consultant Upgrade 2WW referral metrics to gauge General Practice performance may be misleading.
Original languageEnglish
Pages (from-to)597-603
Number of pages7
JournalBritish Journal of Cancer
Volume117
Issue number5
Early online date27 Jul 2017
DOIs
Publication statusPublished - 22 Aug 2017

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Consultants
General Practitioners
Noise
Referral and Consultation
Neoplasms
General Practice
Northern Ireland
Diagnosis-Related Groups
Early Detection of Cancer
Databases

Keywords

  • cancer diagnosis
  • primary care
  • referral
  • general practice
  • consultant upgrade
  • healthcare quality assurance

Cite this

Knowledge or noise? Making sense of General Practitioners’ and Consultant use of two-week-wait referrals for suspected cancer. / Donnelly, Conan ; Hart, Nigel ; McCrorie, Alan David ; Anderson, Lesley ; Donnelly, Michael ; Murchie, Peter; Gavin, Anna .

In: British Journal of Cancer, Vol. 117, No. 5, 22.08.2017, p. 597-603.

Research output: Contribution to journalArticle

Donnelly, Conan ; Hart, Nigel ; McCrorie, Alan David ; Anderson, Lesley ; Donnelly, Michael ; Murchie, Peter ; Gavin, Anna . / Knowledge or noise? Making sense of General Practitioners’ and Consultant use of two-week-wait referrals for suspected cancer. In: British Journal of Cancer. 2017 ; Vol. 117, No. 5. pp. 597-603.
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title = "Knowledge or noise? Making sense of General Practitioners’ and Consultant use of two-week-wait referrals for suspected cancer",
abstract = "Background: Early diagnosis and treatment of cancer is the goal of the 2-week-wait referral pathway (2WW). Variation exists between General Practice use of 2WW and rates of consultant reprioritisation of GP referral from routine to 2WW (Consultant Upgrade). We investigated variation in General Practice and Consultant Upgrade 2WW referral activity. Methods: Data from 185 000 referrals and 29 000 cancers recorded between 2011 and 2013 from the Northern Ireland Cancer Waiting Time database (CaPPS) were analysed to ascertain standardised referral rate ratios, detection rate (DR) (=sensitivity) and conversion rate (CR) (=positive predictive value) for Practice 2WW referrals and Consultant Upgrade 2WW. Metrics were compared using Spearman’s rank correlation co-efficients. Results: There was consistency in Practice and Consultant Upgrade 2WW referral rates over time, though not for annual DR (Spearman’s ρ<0.37) or CR (Spearman’s ρ<0.26). Practice 2WW referral rates correlated negatively with CR and positively with DR while correlations between DR and CR were restricted to single-year comparisons in Practice 2WW. In Consultant Upgrade, 2WW CR and DR were strongly correlated but only when the same cancers were included in both rates. Conclusions: Results suggest ‘random case mix’ explains previously reported associations between CR and DR with more ‘hard to detect’ cancers in some Practices than in others in a given year corresponding to lower DR and CR. Use of Practice and Consultant Upgrade 2WW referral metrics to gauge General Practice performance may be misleading.",
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author = "Conan Donnelly and Nigel Hart and McCrorie, {Alan David} and Lesley Anderson and Michael Donnelly and Peter Murchie and Anna Gavin",
note = "This work was funded by the National Awareness & Early Diagnosis Initiative. It was undertaken in the secure environment of the Northern Ireland Cancer Registry, which is funded by the Northern Ireland Public Health Agency. We are grateful to the staff in the Health & Social Care Board for their advice and guidance on this study.",
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T1 - Knowledge or noise? Making sense of General Practitioners’ and Consultant use of two-week-wait referrals for suspected cancer

AU - Donnelly, Conan

AU - Hart, Nigel

AU - McCrorie, Alan David

AU - Anderson, Lesley

AU - Donnelly, Michael

AU - Murchie, Peter

AU - Gavin, Anna

N1 - This work was funded by the National Awareness & Early Diagnosis Initiative. It was undertaken in the secure environment of the Northern Ireland Cancer Registry, which is funded by the Northern Ireland Public Health Agency. We are grateful to the staff in the Health & Social Care Board for their advice and guidance on this study.

PY - 2017/8/22

Y1 - 2017/8/22

N2 - Background: Early diagnosis and treatment of cancer is the goal of the 2-week-wait referral pathway (2WW). Variation exists between General Practice use of 2WW and rates of consultant reprioritisation of GP referral from routine to 2WW (Consultant Upgrade). We investigated variation in General Practice and Consultant Upgrade 2WW referral activity. Methods: Data from 185 000 referrals and 29 000 cancers recorded between 2011 and 2013 from the Northern Ireland Cancer Waiting Time database (CaPPS) were analysed to ascertain standardised referral rate ratios, detection rate (DR) (=sensitivity) and conversion rate (CR) (=positive predictive value) for Practice 2WW referrals and Consultant Upgrade 2WW. Metrics were compared using Spearman’s rank correlation co-efficients. Results: There was consistency in Practice and Consultant Upgrade 2WW referral rates over time, though not for annual DR (Spearman’s ρ<0.37) or CR (Spearman’s ρ<0.26). Practice 2WW referral rates correlated negatively with CR and positively with DR while correlations between DR and CR were restricted to single-year comparisons in Practice 2WW. In Consultant Upgrade, 2WW CR and DR were strongly correlated but only when the same cancers were included in both rates. Conclusions: Results suggest ‘random case mix’ explains previously reported associations between CR and DR with more ‘hard to detect’ cancers in some Practices than in others in a given year corresponding to lower DR and CR. Use of Practice and Consultant Upgrade 2WW referral metrics to gauge General Practice performance may be misleading.

AB - Background: Early diagnosis and treatment of cancer is the goal of the 2-week-wait referral pathway (2WW). Variation exists between General Practice use of 2WW and rates of consultant reprioritisation of GP referral from routine to 2WW (Consultant Upgrade). We investigated variation in General Practice and Consultant Upgrade 2WW referral activity. Methods: Data from 185 000 referrals and 29 000 cancers recorded between 2011 and 2013 from the Northern Ireland Cancer Waiting Time database (CaPPS) were analysed to ascertain standardised referral rate ratios, detection rate (DR) (=sensitivity) and conversion rate (CR) (=positive predictive value) for Practice 2WW referrals and Consultant Upgrade 2WW. Metrics were compared using Spearman’s rank correlation co-efficients. Results: There was consistency in Practice and Consultant Upgrade 2WW referral rates over time, though not for annual DR (Spearman’s ρ<0.37) or CR (Spearman’s ρ<0.26). Practice 2WW referral rates correlated negatively with CR and positively with DR while correlations between DR and CR were restricted to single-year comparisons in Practice 2WW. In Consultant Upgrade, 2WW CR and DR were strongly correlated but only when the same cancers were included in both rates. Conclusions: Results suggest ‘random case mix’ explains previously reported associations between CR and DR with more ‘hard to detect’ cancers in some Practices than in others in a given year corresponding to lower DR and CR. Use of Practice and Consultant Upgrade 2WW referral metrics to gauge General Practice performance may be misleading.

KW - cancer diagnosis

KW - primary care

KW - referral

KW - general practice

KW - consultant upgrade

KW - healthcare quality assurance

U2 - 10.1038/bjc.2017.213

DO - 10.1038/bjc.2017.213

M3 - Article

C2 - 28751756

VL - 117

SP - 597

EP - 603

JO - British Journal of Cancer

JF - British Journal of Cancer

SN - 0007-0920

IS - 5

ER -