Use of clinical quality indicators to improve lung cancer care in a regional/rural network of health services

Kim, Michelle Lynne; Matheson, Leigh; Garrard, Brooke; Francis, Michael; Broad, Adam; Malone, James P.; Eastman, Peter; Rogers, Mark; Yap, Cheng‐Hon

doi:10.1111/ajr.12493

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…The pathway tools will not achieve maximum success without an actual engagement of the hospital management [33]. Even after the cancer care pathway is implemented, it must be audited periodically, in order to ensure that all aspects of pathway are running optimally [38,49]. This requires a dedicated team of professionals, who can periodically allocate time to hold meetings and monitor the performance of the care pathways, and continuously adjust and improve their content [38].…”

Section: Discussionmentioning

confidence: 99%

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Optimal Care Pathways for People with Lung Cancer- a Scoping Review of the Literature

Otty¹,

Brown²,

Sabesan³

et al. 2020

Int J Integr Care

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Introduction: Much of the existing work around implementation of cancer optimal care pathways (OCP) has either focused exclusively on the clinical elements of care or has targeted individual stages in the cancer trajectory, rather than using a patient-centred or service delivery lens to inform the integration of care across the continuum. This review aimed to identify and summarise the available literature on lung cancer OCP. Methods: A scoping review was conducted, with literature across multiple databases and grey literature searched. Articles were included if the OCP was being used to manage adult patients with lung cancer and reported on either the development process and outcomes and/or barriers and facilitators associated with optimal care pathway development and/or uptake. Results: Of the 381 references screened, 32 articles were included. The lung cancer pathways reviewed varied significantly. A number of themes were identified including the development and implementation of the OCP; the use of quality indicators to audit the OCP; and studies on outcomes of the OCP incorporating timeliness of care delivery, patient experiences and health care utilisation and costs. Conclusions: The limited number of relevant articles found in this review may suggest that an OCP for lung cancer is still in its preliminary stages across the broader health systems.

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Section: Discussionmentioning

confidence: 99%

“…There were five studies on quality indicators and auditing lung cancer pathways [33,37,38,48,49]. The group from the University of Udine in Italy selected quality indicators from international guidelines and after discussions with the local multidisciplinary thoracic malignancy group [33].…”

Section: Using Quality Indicators To Audit Lung Cancer Care Pathwaysmentioning

confidence: 99%

Optimal Care Pathways for People with Lung Cancer- a Scoping Review of the Literature

Otty¹,

Brown²,

Sabesan³

et al. 2020

Int J Integr Care

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“…QIs have been studied in different organ surgeries at different centres including head and neck, 5,6 thyroid, 7 genitourinary, 8 oesophageal, 9,10 gastric, 11,12 colorectal, 13 lung [14][15][16] and pancreatic cancer 17,18 where most of the studies have assessed organ-specific 30or 90-day morbidity or mortality as an outcome measure of the quality of cancer surgery. After an extensive literature search, no study was found that had assessed the QIs of perioperative outcomes in all major oncological surgeries at one tertiary care centre.…”

Section: S No Variablementioning

confidence: 99%

A prospective study evaluating perioperative quality metrics of cancer surgery: Experience from a tertiary care cancer centre in India

Gupta

Deo

Ray

et al. 2023

Journal of Surgical Oncology

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Background Well‐defined quality metrics were studied at this high‐volume tertiary care academic oncology centre to evaluate surgical quality and outcomes. Methods A prospective cohort of 691 patients undergoing major surgeries for all cancers was observed between 1 September 2018 and 30 August 2019 and predefined quality indicators in three categories: namely, optimal hospital resource utilisation, quality of surgery and perioperative outcomes were recorded during their admission period. Surgical procedures were divided into group I versus group II involving simple/moderate complexity versus high complexity procedures for analysis done using appropriate tests in STATA v14.0. Findings There were 373 versus 318 patients in group I versus group II with a mean of 48 years of age and 459 (66.43%) being females. Mean BMI was 24.58 kg/m2, haemoglobin 12.12 g/dL and mean serum albumin of 4.25 g (SD ± 0.6). A total of 667(96.53%) patients had an Eastern Co‐Operative Oncology Group performance score of 1 with 271 (39.22%) having comorbidities and 195 (28.22%) having tobacco/alcohol addictions. A total of 393 (56.87%) patients underwent prehabilitation. 83% of patients belonged to lower‐middle socioeconomic status and 32% of patients had some prior surgical intervention. Neoadjuvant therapy was administered in 44.5% versus 37.42%, mean preoperative hospital stay was 3.65 versus 6.16 days whereas postoperative was 2.6 versus 6.09 days with total stay being 6.27 versus 12.21 days, mean surgical duration was 132 versus 268 min with mean blood loss of 100 versus 245 mL (group I vs. group II, respectively). Intraoperative events, namely, unexpected bleeding and hypotension occurred in 144 (20.84%) patients while packed red blood cells and/or fresh frozen plasma transfusion was required in 56 (8.1%) patients. 40% of patients needed intensive care unit care postoperatively with 45 (6.51%) patients having some event (hypotension, sepsis, acute kidney injury, etc.). A total of 29 (<4%) patients had ≥grade 3 surgical complications while ≥grade 2 medical complications occurred in 6.43% versus 12.58% of patients (group I vs. group II). A total of 90 (13.02%) patients were readmitted, 15 (2.17%) re‐explored and 5 (0.72%) patients died. Conclusion Optimal surgical outcomes in this study compared to international standards underpin the need for well‐defined multidisciplinary perioperative pathways to be followed for each organ system and this framework can be adopted by other cancer centres in LMIC to achieve good surgical outcomes.

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“…A range of Australian regional and state-based initiatives have been developed for improving outcomes in lung cancer care through the use of clinical quality indicators20 65–68 including the Performance Index of the Cancer Institute New South Wales,69 The Queensland Lung Cancer Quality Index,70 Cancer Alliance Queensland71 and the Victorian Lung Cancer Registry (VLCR) 72. These reports include clinical indicators as tools providing methodologically consistent comparators of service provision across institutions and within various jurisdictions and enable delivery of risk adjusted benchmarking 73…”

Section: Introductionmentioning

confidence: 99%

Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry: a protocol paper

et al. 2022

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IntroductionLung cancer is the leading cause of cancer mortality, comprising the largest national cancer disease burden in Australia and New Zealand. Regional reports identify substantial evidence-practice gaps, unwarranted variation from best practice, and variation in processes and outcomes of care between treating centres. The Australia and New Zealand Lung Cancer Registry (ANZLCR) will be developed as a Clinical Quality Registry to monitor the safety, quality and effectiveness of lung cancer care in Australia and New Zealand.Methods and analysisPatient participants will include all adults >18 years of age with a new diagnosis of non-small-cell lung cancer (NSCLC), SCLC, thymoma or mesothelioma. The ANZLCR will register confirmed diagnoses using opt-out consent. Data will address key patient, disease, management processes and outcomes reported as clinical quality indicators. Electronic data collection facilitated by local data collectors and local, state and federal data linkage will enhance completeness and accuracy. Data will be stored and maintained in a secure web-based data platform overseen by registry management. Central governance with binational representation from consumers, patients and carers, governance, administration, health department, health policy bodies, university research and healthcare workers will provide project oversight.Ethics and disseminationThe ANZLCR has received national ethics approval under the National Mutual Acceptance scheme. Data will be routinely reported to participating sites describing performance against measures of agreed best practice and nationally to stakeholders including federal, state and territory departments of health. Local, regional and (bi)national benchmarks, augmented with online dashboard indicator reporting will enable local targeting of quality improvement efforts.

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Use of clinical quality indicators to improve lung cancer care in a regional/rural network of health services

Cited by 8 publications

References 15 publications

Optimal Care Pathways for People with Lung Cancer- a Scoping Review of the Literature

Optimal Care Pathways for People with Lung Cancer- a Scoping Review of the Literature

A prospective study evaluating perioperative quality metrics of cancer surgery: Experience from a tertiary care cancer centre in India

Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry: a protocol paper

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