Building a Multidisciplinary Bridge Across the Quality Chasm in Thoracic Oncology
| Status: | Recruiting |
|---|---|
| Conditions: | Lung Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 11/3/2017 |
| Start Date: | August 2014 |
| End Date: | February 2017 |
| Contact: | Raymond Osarogiagbon |
| Email: | raymond.osarogiagbon@bmg.md |
| Phone: | 9013556340 |
Lung cancer kills 160,000 patients annually; this represents 28% of all US cancer deaths. The
overall year survival rate has only improved from 12% to 17% in 33 years. This failure
reflects the innate lethality of lung cancer, but also reflects defects in patient care
delivery. Care for the lung cancer patient starts with an abnormal radiologic scan, proceeds
through a diagnostic biopsy, tests to determine the extent of spread of the disease (stage),
selection of appropriate treatment, and finally ends with patient outcomes. At each step are
multiple options and independent specialists, each one engaged by a process of sequential
referrals in the serial care model. This process is often not user-friendly, is riddled with
inefficiency, delays, and outcome variances.
The coordinated multidisciplinary model, in which patients and their doctors collaborate to
provide evidence-based care, is believed by experts to be superior, but has few examples of
successful implementation. The implementation gap exists because of the paucity of good
quality data, and lack of implementation know-how.
Embedded in the highest US lung cancer mortality zone, the greater Memphis area has a
racially, culturally, economically and geographically diverse population. The investigators
research group has shown how poor quality care impairs patient survival in this region and in
the greater US. The investigators have linked patient survival to compliance with
multidisciplinary care plans. In this project, the investigators propose to rigorously test
the impact of the multidisciplinary care model on patient outcomes in a community-based,
private practice environment, similar to where 70% of lung cancer care is delivered in the
US.
The objective of this study is to provide high-level evidence of the impact of
multidisciplinary care on lung cancer patient outcomes. Multidisciplinary care is defined as
a model of care in which patients, their care-givers and key specialists concurrently and
directly evaluate the same patients in the presence of the patients and their informal
caregivers, in order to develop evidence-based consensus care plans
overall year survival rate has only improved from 12% to 17% in 33 years. This failure
reflects the innate lethality of lung cancer, but also reflects defects in patient care
delivery. Care for the lung cancer patient starts with an abnormal radiologic scan, proceeds
through a diagnostic biopsy, tests to determine the extent of spread of the disease (stage),
selection of appropriate treatment, and finally ends with patient outcomes. At each step are
multiple options and independent specialists, each one engaged by a process of sequential
referrals in the serial care model. This process is often not user-friendly, is riddled with
inefficiency, delays, and outcome variances.
The coordinated multidisciplinary model, in which patients and their doctors collaborate to
provide evidence-based care, is believed by experts to be superior, but has few examples of
successful implementation. The implementation gap exists because of the paucity of good
quality data, and lack of implementation know-how.
Embedded in the highest US lung cancer mortality zone, the greater Memphis area has a
racially, culturally, economically and geographically diverse population. The investigators
research group has shown how poor quality care impairs patient survival in this region and in
the greater US. The investigators have linked patient survival to compliance with
multidisciplinary care plans. In this project, the investigators propose to rigorously test
the impact of the multidisciplinary care model on patient outcomes in a community-based,
private practice environment, similar to where 70% of lung cancer care is delivered in the
US.
The objective of this study is to provide high-level evidence of the impact of
multidisciplinary care on lung cancer patient outcomes. Multidisciplinary care is defined as
a model of care in which patients, their care-givers and key specialists concurrently and
directly evaluate the same patients in the presence of the patients and their informal
caregivers, in order to develop evidence-based consensus care plans
Within the Baptist Memorial Health Care system, the Multidisciplinary Thoracic Oncology
Program has two components: Primarily, the program is centered in a multidisciplinary clinic,
wherein patients and their informal caregivers are seen by multiple specialists at a single
appointment time; secondarily, the program includes a multidisciplinary conference, wherein
all of the specialists potentially involved in lung cancer care discuss patients referred for
presentation and make consensus recommendations for care. This study focuses primarily on the
experience and outcomes of care delivered to patients evaluated in the multidisciplinary
clinic. However, data from the conference will also be included in some aspects of the study.
The goal is to improve the access and quality of thoracic oncologic care delivery within the
Baptist Healthcare System The investigators specific aim is to perform a prospective, matched
cohort comparative effectiveness study of patients receiving serial vs. multidisciplinary
care, with key patient-centered endpoints (survival, stakeholder satisfaction with the care
experience, timeliness and stage-appropriateness of care, quality of staging). Serial care is
defined as the current system of linear, sequential, referral-based care delivery.
Program has two components: Primarily, the program is centered in a multidisciplinary clinic,
wherein patients and their informal caregivers are seen by multiple specialists at a single
appointment time; secondarily, the program includes a multidisciplinary conference, wherein
all of the specialists potentially involved in lung cancer care discuss patients referred for
presentation and make consensus recommendations for care. This study focuses primarily on the
experience and outcomes of care delivered to patients evaluated in the multidisciplinary
clinic. However, data from the conference will also be included in some aspects of the study.
The goal is to improve the access and quality of thoracic oncologic care delivery within the
Baptist Healthcare System The investigators specific aim is to perform a prospective, matched
cohort comparative effectiveness study of patients receiving serial vs. multidisciplinary
care, with key patient-centered endpoints (survival, stakeholder satisfaction with the care
experience, timeliness and stage-appropriateness of care, quality of staging). Serial care is
defined as the current system of linear, sequential, referral-based care delivery.
Inclusion Criteria:
- All patients who undergo care for lung cancer or an undiagnosed lung mass within the
Baptist Memorial Health Care Corporation's hospitals from January 1, 2009 until the end of
the defined study period will be eligible for inclusion in the data collection for this
study. In addition, caregivers of patients within the same institution and within the study
window, clinical care providers (doctors and nurses) who have taken care of patients within
the eligible institutions during the study window.
Exclusion Criteria:
- Patients who do not have a radiology-identified lung lesion or lung cancer are
excluded from this study.
- Patients not receiving care within the Baptist Memorial Healthcare Corporation are
excluded from this study.
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