The Patient-Reported Observations on Medical Procedure Timeliness (PROMPT) for Breast Patients study, a 2-year quality collaborative of the ACS National Accreditation Program for Breast Centers (NAPBC), was completed in January 2024.
In the first year of PROMPT, 322 NAPBC-accredited sites contributed data from 2019 to 2021 on four timely metrics:
- Time from screening mammogram to diagnostic mammogram
- Time from diagnostic mammogram to biopsy
- Time from biopsy to neoadjuvant therapy
- Time from biopsy to surgery
Additionally, patient perceptions were gathered on timely care from screening to treatment through qualitative interviews. In the second year of PROMPT, approximately 207 sites conducted individual site-specific quality improvement (QI) projects using the ACS Quality Framework.
Overall, PROMPT was well received by NAPBC sites. Approximately 58% of all accredited NAPBC sites participated in the first year of PROMPT, and of the sites that submitted timely data, 63% completed all steps of the ACS Quality Framework for their QI projects.
The timely metrics submitted by participating sites in year 1 of PROMPT were examined. The metric data demonstrated that time intervals from screening to diagnostic biopsy were, on average, shorter than biopsy to treatment. The median number of days from screening mammogram (MGM) to diagnostic MGM was 11, from diagnostic MGM to biopsy was 8 days, but from biopsy to surgery, the median number of days ranged from 39 to 42 days. Not surprisingly, a marked decrease was observed in the number of days for all four time intervals during the first few months of the COVID-19 pandemic in 2020. Fortunately, time intervals for all four metrics resumed pre-pandemic levels within 2 months.
Year 1 also revealed some important patient perceptions from the patient interviews. One important finding from PROMPT was comparing patient preferences for the aforementioned time intervals (i.e., screening MGM to diagnostic MGM) to actual timelines collected through PROMPT.
Overall, patients preferred shorter time intervals from screening MGM to treatment compared to time intervals reported in PROMPT. Patients preferred a time interval of 5 days from screening MGM to diagnostic MGM (compared to 11 days in PROMPT) and 21 days from biopsy to surgery (compared to 42 days in PROMPT). Patients reported many barriers to achieving timely care. Factors such as difficulty scheduling appointments, second opinions, and additional testing and consultations delayed care. Issues with insurance coverage, financial constraints, and transportation barriers also were obstacles to getting timely care.
The second year of PROMPT wrapped up in January 2024. Sites submitted their individual QI projects using the ACS Quality Framework. PROMPT gave each site a choice as to which timely metric they wanted to improve. Fifty-one (24%) sites picked the screening to diagnostic MGM time interval, 58 (27%) selected the diagnostic MGM to biopsy interval, 62 (29%) chose the biopsy to neoadjuvant therapy interval, and 42 (20%) selected the biopsy to surgery interval.
Each site developed a problem statement, aim statement, root causes, interventions, barriers, and a sustainability plan. More than 75% of the sites that focused on time from screening to diagnosis stated their QI project was successful compared to approximately 50% of sites that focused on time from biopsy to treatment. This finding was not surprising given the increased number of steps it takes to get a patient from diagnosis to treatment as opposed to screening to diagnosis. There is much more to learn from PROMPT, thanks to the many sites and patients who participated.
