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Stone CJL, Johnson AP, Robinson D, Katyukha A, Egan R, Linton S, Parker C, Robinson A, Digby GC. Health Resource and Cost Savings Achieved in a Multidisciplinary Lung Cancer Clinic. Curr Oncol 2021; 28:1681-1695. [PMID: 33947127 PMCID: PMC8161784 DOI: 10.3390/curroncol28030157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Lung cancer (LC) care is resource and cost intensive. We launched a Multidisciplinary LC Clinic (MDC), where patients with a new LC diagnosis received concurrent oncology consultation, resulting in improved time to LC assessment and treatment. Here, we evaluate the impact of MDC on health resource utilization, patient and caregiver costs, and secondary patient benefits. Methods: We retrospectively analyzed patients in a rapid assessment clinic with a new LC diagnosis pre-MDC (September 2016-February 2017) and post-MDC implementation (February 2017-December 2018). Data are reported as means; unpaired t-tests and ANOVA were used to assess for significance. We also conducted a cost analysis. Resource utilization, out-of-pocket costs, procedure-related costs, and indirect costs were evaluated from the societal perspective and presented in 2019 Canadian dollars (CAD); multi-way worst/best case and threshold sensitivity analyses were conducted. Results: We reviewed 428 patients (78 traditional model, 350 MDC). Patients in the MDC model required significantly fewer oncology visits from LC diagnosis to first LC treatment (1.62 vs. 2.68, p < 0.001), which was significant for patients with stage 1, 3, and 4 disease. Compared with the traditional model, there was no change in mean biopsies/patient (1.32 traditional vs. 1.17 MDC, p = 0.18) or staging investigations/patient (2.24 traditional vs. 2.02 MDC, p = 0.20). Post-MDC, there was an increase in invasive mediastinal staging for patients with stage 2/3 LC (15.0% vs. 60.0%, p < 0.001). Over 22 months, MDC resulted in savings of CAD 48,389 including CAD 24,167 CAD in direct patient out-of-pocket expenses. For the threshold analyses, MDC was estimated to cost CAD 25,708 per quality-adjusted life year (QALY), considered to be below current willingness to pay thresholds (at CAD 80,000 per QALY). MDC also facilitated oncology assessment for 29 non-LC patients. Conclusions: An MDC led to a reduction in patient visits and direct patient and caregiver costs.
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Affiliation(s)
| | - Ana P. Johnson
- Department of Public Health Science, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Danielle Robinson
- School of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada; (D.R.); (A.K.)
| | - Andriy Katyukha
- School of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada; (D.R.); (A.K.)
| | - Rylan Egan
- School of Nursing, Queen’s University, Kingston, ON K7L 3N6, Canada;
| | - Sophia Linton
- Department of Medicine, Queen’s University, Kingston, ON K7L 5P9, Canada; (S.L.); (C.P.)
| | - Christopher Parker
- Department of Medicine, Queen’s University, Kingston, ON K7L 5P9, Canada; (S.L.); (C.P.)
| | - Andrew Robinson
- Department of Oncology, Queen’s University, Kingston, ON K7L 5P9, Canada;
| | - Geneviève C. Digby
- Department of Medicine, Queen’s University, Kingston, ON K7L 5P9, Canada; (S.L.); (C.P.)
- Department of Oncology, Queen’s University, Kingston, ON K7L 5P9, Canada;
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Mullin MLL, Tran A, Golemiec B, Stone CJL, Noseworthy C, O'Callaghan N, Parker CM, Digby GC. Improving Timeliness of Lung Cancer Diagnosis and Staging Investigations Through Implementation of Standardized Triage Pathways. JCO Oncol Pract 2020; 16:e1202-e1208. [PMID: 32639927 DOI: 10.1200/jop.19.00807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Timely care for patients with lung cancer (LC) is associated with improved clinical outcomes. In Southeastern Ontario, Canada, we identified delays in the diagnostic process for patients undergoing evaluation for suspected LC through a rapid assessment clinic. We developed improvement initiatives with an aim of reducing the time from referral to diagnosis. METHODS A Standardized Triage Process (STP) was implemented for patients referred with suspected LC, including routine interdisciplinary triage, standardized pathways with preordered staging tests, and a new Small Nodule Clinic. We retrospectively analyzed all patients referred pre-STP (January to April 2018) and prospectively for improvement (May 2018 to March 2019). Process measures included STP compliance and time to completion of staging investigations (positron emission tomography [PET] and computed tomography/magnetic resonance imaging of brain). Data are reported as means; significance was determined by special-cause variation using Statistical Process Control charts; unpaired t tests were compared between groups. RESULTS We reviewed 833 referrals (207 baseline and 626 post-STP). STP compliance improved monthly to 99.4%. Post-STP, time from referral to PET decreased (from 38.5 to 15.7 days), time from referral to brain imaging decreased (from 33.4 to 13.1 days), and time from referral to diagnosis decreased (from 38.0 to 22.7 days), all demonstrating special-cause variation. Patients completing preordered staging tests experienced significantly faster care than those without preordered tests, including time to PET (23.0 v 35.9 days), computed tomography/magnetic resonance imaging of brain (16.2 v 29.9 days), and diagnosis (39.9 v 28.1 days), all P < .001. CONCLUSION An STP significantly improved timeliness of diagnosis and staging for patients with suspected LC undergoing evaluation in a rapid assessment clinic.
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Affiliation(s)
| | - Audrey Tran
- Queen's University, Kingston, Ontario, Canada
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Linford G, Egan R, Coderre-Ball A, Dalgarno N, Stone CJL, Robinson A, Robinson D, Wakeham S, Digby GC. Patient and physician perceptions of lung cancer care in a multidisciplinary clinic model. ACTA ACUST UNITED AC 2020; 27:e9-e19. [PMID: 32218663 DOI: 10.3747/co.27.5499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Lung cancer (lc) is a complex disease requiring coordination of multiple health care professionals. A recently implemented lc multidisciplinary clinic (mdc) at Kingston Health Sciences Centre, an academic tertiary care hospital, improved timeliness of oncology assessment and treatment. This study describes patient, caregiver, and physician experiences in the mdc. Methods We qualitatively studied patient, caregiver, and physician experiences in a traditional siloed care model and in the mdc model. We used purposive sampling to conduct semi-structured interviews with patients and caregivers who received care in one of the models and with physicians who worked in both models. Thematic design by open coding in the ATLAS.ti software application (ATLAS.ti Scientific Software Development, Berlin, Germany) was used to analyze the data. Results Participation by 6 of 72 identified patients from the traditional model and 6 of 40 identified patients from the mdc model was obtained. Of 9 physicians who provided care in both models, 8 were interviewed (2 respirologists, 2 medical oncologists, 4 radiation oncologists). Four themes emerged: communication and collaboration, efficiency, quality of care, and effect on patient outcomes. Patients in both models had positive impressions of their care. Patients in the mdc frequently reported convenience and a positive effect of family presence at appointments. Physicians reported that the mdc improved communication and collegiality, clinic efficiency, patient outcomes and satisfaction, and consistency of information provided to patients. Physicians identified lack of clinic space as an area for mdc improvement. Conclusions This qualitative study found that a lc mdc facilitated patient communication and physician collaboration, improved quality of care, and had a perceived positive effect on patient outcomes.
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Affiliation(s)
- G Linford
- Department of Oncology, Cancer Centre of Southeastern Ontario
| | - R Egan
- School of Nursing, Queen's University
| | - A Coderre-Ball
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University
| | - N Dalgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University
| | - C J L Stone
- Department of Medicine, Kingston Health Sciences Centre
| | - A Robinson
- Department of Oncology, Cancer Centre of Southeastern Ontario
| | | | - S Wakeham
- School of Medicine, Queen's University
| | - G C Digby
- Department of Oncology, Cancer Centre of Southeastern Ontario.,Department of Medicine, Kingston Health Sciences Centre.,Division of Respirology, Kingston Health Sciences Centre, Queen's University, Kingston, ON
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Stone CJL, Robinson A, Brown E, Mates M, Falkson CB, Owen T, Ashworth A, Parker CM, Mahmud A, Tomiak A, Thain SK, Gregg R, Reid KR, Chung W, Digby GC. Improving Timeliness of Oncology Assessment and Cancer Treatment Through Implementation of a Multidisciplinary Lung Cancer Clinic. J Oncol Pract 2019; 15:e169-e177. [PMID: 30615586 DOI: 10.1200/jop.18.00214] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Timely lung cancer care has been associated with improved clinical outcomes and patient satisfaction. We identified improvement opportunities in lung cancer management pathways at Kingston Health Sciences Centre. Quality improvement strategies led to the implementation of a multidisciplinary lung cancer clinic (MDC). METHODS We set an outcome measure of decreasing the time from diagnosis to first cancer treatment by 10 days within 6 months of clinic implementation. We implemented a weekly MDC that involved respirologists, medical oncologists, and radiation oncologists at which patients with new lung cancer diagnoses were offered concurrent oncology consultation. We used Plan-Do-Study-Act cycles to guide our improvement initiatives. A total of five Plan-Do-Study-Act cycles spanned 14 months and consisted of an MDC pilot clinic, large-scale MDC launching, debriefing meetings, and clinic expansion. Pre-MDC data were analyzed retrospectively to establish baseline and prospectively for improvement. Statistical Process Control XmR(i) charts were used to report data. RESULTS Since MDC initiation, 128 patients have been seen in 34 MDC clinics (3.8 patients per clinic). Mean days from diagnosis to first oncology assessment decreased from 12.4 days to 3.9 days, and mean days from diagnosis to first cancer treatment decreased from 39.5 to 15.0 days, both of which demonstrated special cause variation. Time to assessment and treatment improved for patients with every stage of lung cancer and for both small-cell and non-small-cell subtypes. CONCLUSION MDC shortens the time from lung cancer diagnosis to oncology assessment and treatment. Time to treatment improved more than time to oncology assessment, which suggests the improvement is related to benefits beyond faster oncology assessment.
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Affiliation(s)
| | | | - Erin Brown
- 1 Queen's University, Kingston, Ontario, Canada
| | | | | | | | | | | | | | - Anna Tomiak
- 1 Queen's University, Kingston, Ontario, Canada
| | | | | | | | - Wiley Chung
- 1 Queen's University, Kingston, Ontario, Canada
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