Victorian Lung Cancer Service Redesign Project: impacts of a quality improvement collaborative on timeliness and management in lung cancer

Abstract

Background: Lung cancer management is characterised by a high disease burden, poor survival and substantial variation in management and outcomes. Service redesign provides opportunities for quality improvement (QI) and this improvement may be leveraged across multiple sites using QI collaboration.Aim: This initiative targeted Quality Improvement (QI) in lung cancer management, engaging a QI collaborative using service redesign methodologies in five Victorian hospitals. QI targets included timeliness from referral and diagnosis to treatment, multi-disciplinary meeting (MDM) presentation and supportive care screening. Redesign strategies targeted process sustainability through enhanced team capability.Methods: This study engaged a prospective quality improvement cohort design targeting newly diagnosed tissue confirmed lung cancer with 6-month pre-intervention period and 6-month redesign implementation period, between September 2016 and August 2017, evaluated using Interrupted Time Series Analysis. Hospital sites included three regional and two metropolitan hospitals in Victoria. QI redesign targeted time intervals from referral to first specialist appointment (FSA), referral to diagnosis, diagnosis to first treatment (any intent), MDM documented in medical records and Supportive Care Screening Tool documented in medical records.Results: There was a marked reduction in referral to FSA interval across all sites, with median (interquartile range) falling from 6 (0-15) to 4 (1-10) days, and proportion seen by a specialist within 14 days increased from 74.3% to 84.2%. The interval between diagnosis and treatment was not substantively changed in the 6-month implementation period. The proportion of subjects with documented presentation to the MDM increased from 61% to 67%. The proportion for which Supportive Care Screening documentation remained low at 26.3% post-intervention.Conclusions: Data-driven redesign initiatives enable identification and analysis of clinical practice variation and may be utilised to enhance timeliness of cancer care and improve local data service capabilities.

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

“…The registry has provided a framework to facilitate quality improvement collaboratives in a learning health system to drive multisite data-driven Open access improvement in lung cancer management. 78 The…”

“…The registry has provided a framework to facilitate quality improvement collaboratives in a learning health system to drive multisite data-driven improvement in lung cancer management. 78 The VLCR is located within the Department of Epidemiology and Preventive Medicine at Monash University which manages the registry’s core activities under the direction of the VLCR Steering Committee. The Monash Clinical Registry Unit currently houses 35 clinical quality registries, 79 including 6 national cancer registries in the School of Public Health and Preventive Medicine, and has established robust protocols for data capture, transmission, security and custodianship, as well as outlier management and accountability for the privacy, security and integrity of patient information held within the registry.…”

“…A dataset has been developed containing key quality process and outcome measures with descriptors of patient, disease, management and outcomes for Victorian patients with lung cancer ( figure 3 ). The registry has provided a framework to facilitate quality improvement collaboratives in a learning health system to drive multisite data-driven improvement in lung cancer management 78. The VLCR is located within the Department of Epidemiology and Preventive Medicine at Monash University which manages the registry’s core activities under the direction of the VLCR Steering Committee.…”

Interventions to improve early cancer diagnosis of symptomatic individuals: a scoping review

“…Three multidisciplinary team lung cancer approaches were identified from published articles: from the USA 68 85 and Australia. 50 The focus and metrics for assessment of the effectiveness of the approaches varied across the publications. One approach from the USA was found to be effective, 68 whereas the others were found to be ineffective.…”

“…68 The ineffective approaches were the pre-diagnosis multidisciplinary tumour board (physicians from radiology, medical and radiation oncology, and pulmonary medicine) discussions in a clinic in Cleveland, USA aimed at improving the timeliness of diagnostic evaluation in lung cancer, 85 and the Victorian lung cancer service redesign project in Victoria, Australia, which involved multidisciplinary (patients, governance, administration, clinicians and health information services) evaluation aimed at quality improvement collaborative on timeliness and management in lung cancer. 50 In addition, nine unpublished articles from the UK were identified. 99 101-103 106 108 109 112 These included four articles regarding a 'straight to CT access' pathway, on community pharmacy direct referral to lung cancer pathway, rapid colorectal diagnostic pathway, and optometrist direct referral to neuroscience pathway.…”