{
  "abstract": "Background We previously developed a digital quality measure (dQM) of emergency presentations (EPs) in colorectal cancer (CRC) and found it to be associated with worse outcomes. Potentially avoidable EPs were common in this cohort, but identifying them required time-intensive chart reviews. We aimed to enhance the existing dQM to automate the detection of potentially avoidable EPs.Materials and methods We defined potentially avoidable EPs as those preceded by a CRC red flag (iron-deficiency anaemia or haematochezia ≥60 days prior, or positive stool-based screening test ≥180 days prior). The enhanced dQM was applied to a national cohort of incident CRC cases diagnosed in the Veterans Affairs healthcare system from 2017 to 2021. We examined associations with cancer stage, treatment and mortality.Results The enhanced dQM had a positive predictive value of 92% (95% CI 85.5% to 95.7%) for identifying potentially avoidable EPs. Among 9096 CRC cases, 28.1% were identified as EPs. Of these, 31.6% were classified as potentially avoidable. These patients were more likely to have advanced-stage disease (adjusted OR 1.50; 95% CI 1.27 to 1.78), less likely to receive treatment (adjusted OR 0.58; 95% CI 0.48 to 0.70) and had higher mortality (adjusted HR 1.58; 95% CI 1.40 to 1.79) compared with other patients with CRC.Conclusions The enhanced dQM accurately identified potentially avoidable EPs, which were associated with worse outcomes. This measure is unique in its focus on cases of preventable care delays, which can help guide future efforts to improve diagnostic timeliness and reduce EPs among patients with CRC.",
  "authors": [
    {
      "affiliations": [
        "Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA",
        "Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Natalia Khalaf"
    },
    {
      "affiliations": [
        "Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Basim Ali"
    },
    {
      "affiliations": [
        "Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA",
        "Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Andrew Zimolzak"
    },
    {
      "affiliations": [
        "Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA",
        "Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Yan Liu"
    },
    {
      "affiliations": [
        "Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA"
      ],
      "name": "Li Wei"
    },
    {
      "affiliations": [
        "Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA",
        "Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Fasiha Kanwal"
    },
    {
      "affiliations": [
        "Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas, USA",
        "Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Hardeep Singh"
    }
  ],
  "title": "Digital quality measure of potentially avoidable emergency presentations among patients with colorectal cancer",
  "uid": "214d3def-9f7e-509d-a930-3b360011e6f9"
}