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Epidemiology

A digital quality measure for emergency presentation of pancreatic cancer

British Journal of Cancer (2026)Cite this article

Subjects

Abstract

Background

Over half of patients with pancreatic cancer experience an emergency cancer diagnosis, but tools for large-scale study are lacking. Towards this end, we developed a digital quality measure (dQM) to automate the detection of pancreatic cancer emergency presentations (EPs).

Methods

A dQM for pancreatic cancer EPs was developed within the U.S. Veterans Affairs health care system. Multivariable regression models were used to study the associations between EPs and cancer outcomes. Records of EP cases were manually reviewed to identify missed opportunities in diagnosis.

Results

The dQM had a positive predictive value of 86.4% (95% CI 80.0–92.8) for accurately identifying EPs among patients with pancreatic cancer. Among 4415 pancreatic cancer patients, 60.9% were identified as EPs by the measure. Patients with EPs had more advanced-stage disease (adjusted OR 1.38; 95% CI 1.20–1.59) and higher mortality (adjusted HR 1.64; 95% CI 1.51–1.77). Nearly one in five EP cases had missed opportunities in diagnosis.

Conclusions

Our dQM had strong performance characteristics for identifying pancreatic cancer EPs, which were independently associated with worse patient outcomes. A notable subset of cases was potentially avoidable. The dQM is a promising strategy for health care systems to identify and measure EPs for quality improvement initiatives.

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Fig. 1: Emergency presentation timeline and operational definition.
Fig. 2: Flow diagram of digital quality measure (dQM) criteria and chart review process.
Fig. 3

Data availability

The data underlying this article cannot be publicly shared due to legal restrictions on access to veteran health data by the VA. The analytic data sets for this study are permitted to leave the VA firewall only with an approved Data Use Agreement. However, the data can be made available to researchers behind the VA firewall after VA study protocol approval. Additional information can be obtained by visiting https://www.virec.research.va.gov or contacting the VA Information Resource Center (VIReC) at vog.av@CeRIV.

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Acknowledgements

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Funding

This work was supported in part by the Texas Medical Center Digestive Diseases Center (PHS grant P30DK056338), the Gordon and Betty Moore Foundation (Diagnostic Excellence Award, grant number: GBMF11505), and the Houston Veterans Administration (VA) Health Systems Research (HSR) Center for Innovations in Quality, Effectiveness and Safety (CIN13-413). In addition, Dr. Khalaf is supported in part by a VA HSR Career Development Award (1 IK2 HX003346-01A2), and Dr. Singh is supported in part by the Agency for Healthcare Research and Quality (R18 HS029347 and R01 HS028595).

Author information

Authors and Affiliations

  1. Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA

    Natalia Khalaf, Andrew J. Zimolzak, Yan Liu & Hardeep Singh

  2. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Natalia Khalaf, Gabriel Sandoval & Yan Liu

  3. Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Andrew J. Zimolzak & Hardeep Singh

  4. Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Paarth Kapadia

  5. Texas Medical Center Digestive Diseases Center (DDC), Houston, TX, USA

    Yan Liu

Authors
  1. Natalia Khalaf
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  2. Gabriel Sandoval
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  3. Andrew J. Zimolzak
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  4. Paarth Kapadia
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  6. Hardeep Singh
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Contributions

Natalia Khalaf (Conceptualization; Data curation; Formal analysis; Funding acquisition; Methodology; Project administration; Resources; Visualization; Writing—original draft; Writing—review & editing), Gabriel Sandoval (Formal analysis; Writing—original draft; Writing—review & editing), Andrew J. Zimolzak and Paarth Kapadia (Conceptualization; Data curation; Formal analysis; Methodology; Writing—review & editing), Yan Liu (Data curation; Formal analysis; Software; Writing—review & editing), Hardeep Singh (Conceptualization; Formal analysis; Funding acquisition; Methodology; Resources; Writing—original draft; Writing—review & editing).

Corresponding author

Correspondence to Natalia Khalaf.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The requirement for informed consent was waived for this study because it is a retrospective chart review study involving minimal risk to participants. All study procedures involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. The study was approved by the institutional review board of Baylor College of Medicine and the Research and Development Committee at the Michael E. DeBakey Veterans Affairs Medical Center (protocol H-43229).

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Khalaf, N., Sandoval, G., Zimolzak, A.J. et al. A digital quality measure for emergency presentation of pancreatic cancer. Br J Cancer (2026). https://doi.org/10.1038/s41416-026-03343-y

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