Adopting Integrated Care Pathways in Non–Small-Cell Lung Cancer: From Theory to Practice

Fasola, Gianpiero; Rizzato, Simona; Merlo, V.; Aita, Marianna; Ceschia, Tino; Giacomuzzi, Francesco; Lugatti, Emilio; Meduri, Stefano; Morelli, Angelo; Rocco, Maurizio; Tozzi, Valeria Domenica

doi:10.1097/jto.0b013e318257fbfe

Cited by 21 publications

(21 citation statements)

References 31 publications

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“…Those patients who underwent EBUS-TBNA as 2nd or 3rd procedure in the group requiring repeat procedure, did not require any procedure thereafter. It is noteworthy that 82% of the patients had lesion accessible by convex probe EBUS in our cohort either in the form of mediastinal/hilar lymph nodes, or intraparenchymal lesions both of which could be aspirated by convex probe EBUS-TBNA, 25 – 29 but it was only done in 22% (n = 23) of the patients. It is conceivable that had these patients undergone EBUS-TBNA, the number of procedure required may have been less, and the delay in the diagnosis may have been reduced in a larger number of patients.…”

Section: Discussionmentioning

confidence: 86%

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Timeliness of Diagnosing Lung Cancer

et al. 2015

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To study number of procedures and time to diagnose lung cancer and factors affecting the timeliness of clinching this diagnosis.Retrospective cohort study of lung cancer patients who consecutively underwent diagnostic bronchoscopy in 1 year (October 2013 to September 2014).Out of 101 patients diagnosed with lung cancer from bronchoscopy, average time interval between first abnormal computed tomogram (CT) scan-to-1st procedure, 1st procedure-to-diagnosis, and 1st abnormal CT scan-to-diagnosis was 16 ± 26, 11 ± 19, and 27 ± 33 days, respectively. These intervals were significantly longer in those requiring repeat procedures. Multivariate analysis revealed inconclusive 1st procedure to be the predictor of prolonged (>30 days) CT scan to diagnosis time (P = 0.04). Twenty-nine patients (28.7%) required repeat procedures (n = 63). Reasons behind repeating the procedures were inadequate procedure (n = 14), inaccessibility of lesion (n = 9), inappropriate procedure (n = 5), mutation analysis (n = 2), and others (n = 2). Fifty had visible endo-bronchial lesion, 20 had positive bronchus sign, and 83 had enlarged mediastinal/hilar lymph-nodes or central masses adjacent to the airways. Fewer procedures, and shorter procedure to diagnosis time, were observed in those undergoing convex probe endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) (P = 0.04).Most patients exhibit enlarged mediastinal lymph node or mass adjacent to the central airway accessible by convex probe EBUS-TBNA. Hence, combining it with conventional bronchoscopic techniques such as bronchoalveolar lavage, brush, and forceps biopsy increases detection rate, and reduces number of procedures and time to establish diagnosis. This may translate into cost and resource savings, timeliness of diagnosis, greater patient satisfaction, and conceivably better outcomes.

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Section: Discussionmentioning

confidence: 86%

“…The wide availability of evidence-based guidelines 23 provides guidance about the choice of procedures and has improved clinical effectiveness but does not automatically translate into the development of leading-edge care models. 24 , 25 …”

Section: Introductionmentioning

confidence: 99%

Timeliness of Diagnosing Lung Cancer

et al. 2015

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“…Three manuscripts were excluded on the basis of the full-text evaluation [36][37][38]. Indicators were extracted from the 14 remaining papers [7,9,[39][40][41] and matched with a guidance. A set of n = 34 indicators, each assessing a recommendation, was included in the web-based questionnaire for the rst round of the Delphi process.…”

Section: Review Of the Literature And Identi Cation Of Candidate Indimentioning

confidence: 99%

Indicators of Guideline-Concordant Care in Lung Cancer Defined with a Modified Delphi Method and Piloted in a Cohort of Over 5,800 Cases

Andreano

Valsecchi

Russo

et al. 2020

Preprint

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BACKGROUND to identify indicators of guideline-concordant care in lung cancer, to implement such indicators with cancer registry data linked to health databases, and to pilot them in a cohort of patients from the cancer registry of the Milan Province. METHODS thirty-four indicators were selected by revision of main guidelines by cancer epidemiologists, and then evaluated by a multidisciplinary panel of clinicians involved in lung cancer care and working on the pathway of lung cancer diagnosis and treatment in the Lombardy region, Italy. With a modified Delphi method, they assessed for each indicator the content validity as a quality measure of the care pathway, the degree of modifiability from the health professional, and the relevance to the health professional. Feasibility was assessed using the cancer registry and the routine health records of the Lombardy region. Feasible indicators were then calculated in the cohort of lung cancer patients diagnosed in 2007‑2012 derived from the cancer registry of the Milan Province. Criterion validity was assessed reviewing clinical records of a random sample of 114 patients (threshold for acceptable discordance ≤ 20%). Finally, reliability was evaluated at the provider level. RESULTS initially, 34 indicators were proposed for evaluation in the first Delphi round. Of the finally 22 selected indicators, 3 were not feasible because the required information was actually not available. The remaining 19 were calculated on the pilot cohort. After assessment of criterion validity (3 eliminated), 16 indicators were retained in the final set and evaluated for reliability. CONCLUSION the developed and piloted set of indicators is now available to implement and monitor, over time, quality initiatives for lung cancer care in the studied health system.

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“…In the August 2012 issue of Journal of Thoracic Oncology, we were encouraged to analyze the processes in care for non-small-cell lung cancer patients to narrow the gap between desired and actual performance. 1 In this letter I would like to affirm the importance of selecting valid quality indicators (QI) that are internationally applicable.…”

Section: Adopting Integratedmentioning

confidence: 99%

“…The valiity of the QI lies in the data quality and an evidence-based link between indicator, clinical outcome, and recognized guidelines. [1][2][3][4] Quality indicators must be able to identify room for improvement, have wide patient applicability, and be sensitive to differences in quality of care. 3 QIs have been used in evaluating processes of care during pulmonary resection; however, the selection process often hinges on the consensus of ad hoc specialist groups.…”

Section: Adopting Integratedmentioning

confidence: 99%