The Victorian Lung Cancer Service Redesign Project: Impacts of a Quality Improvement collaborative on timeliness and management in lung cancer

Lung Cancer
08/09/2020

Intern Med J. 2020 Sep 8. doi: 10.1111/imj.15043. Online ahead of print.

ABSTRACT

OBJECTIVES: This initiative targeted Quality Improvement (QI) in lung cancer management, engaging a Quality Improvement 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.

DESIGNS: Prospective quality improvement cohort study with 6-month pre-intervention period and 6-month redesign implementation period, between September 2016 and August 2017, evaluated using Interrupted Time Series (ITS) analysis.

SETTING: Three regional and two metropolitan hospitals in Victoria.

PARTICIPANTS: Newly diagnosed, tissue confirmed lung cancer.

INTERVENTION: Site specific quality improvement service redesign.

MAIN OUTCOME MEASURES: 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 (SCST) documented in medical records.

RESULTS: There was a marked reduction in referral to FSA interval across all sites, with median (IQR) 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 to 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 whom 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. This article is protected by copyright. All rights reserved.