Facility Characteristics and Quality of Lung Cancer Care in an Integrated Health Care System

Ryoo, Jean J.; Malin, Jennifer L.; Ordin, Diana L.; Oishi, Sabine; Kim, Benjamin; Asch, Steven M.; He, Renjie; Gould, Michael K.

doi:10.1097/jto.0000000000000108

Cited by 12 publications

(10 citation statements)

References 27 publications

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“…Indeed, there are several reasons to believe that the VA may be better prepared for lung cancer screening implementation than are many hospitals in the private sector. First, the VA, the nation's largest integrated health system, has a proven track record in providing high-quality preventive care and care for chronic illnesses (37)(38)(39) and is undertaking implementation of lung cancer screening in a deliberate fashion (17,40). Second, VA facilities are more likely than are many academic and community hospitals to have processes of care in place to facilitate pulmonary nodule evaluation (41).…”

Section: Original Researchmentioning

confidence: 99%

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

et al. 2016

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Rationale: To mitigate the potential harms of screening, professional societies recommend that lung cancer screening be conducted in multidisciplinary programs with the capacity to provide comprehensive care, from screening through pulmonary nodule evaluation to treatment of screen-detected cancers. The degree to which this standard can be met at the national level is unknown.Objectives: To assess the readiness of clinical facilities in a national healthcare system for implementation of comprehensive lung cancer screening programs, as compared with the ideal described in policy recommendations.Methods: This was a cross-sectional, self-administered survey of staff pulmonologists in pulmonary outpatient clinics in Veterans Health Administration facilities. Measurements and Main Results:The facility-level response rate was 84.1% (106 of 126 facilities with pulmonary clinics); 88.7% of facilities showed favorable provider perceptions of the evidence for lung cancer screening, and 73.6% of facilities had a favorable provider-perceived local context for screening implementation. All elements of the policyrecommended infrastructure for comprehensive screening programs were present in 36 of 106 facilities (34.0%); the most common deficiencies were the lack of on-site positron emission tomography scanners or radiation oncology services. Overall, 26.5% of Veterans Health Administration facilities were ideally prepared for lung cancer screening implementation (44.1% if the policy recommendations for on-site positron emission tomography scanners and radiation oncology services were waived).Conclusions: Many facilities may be less than ideally positioned for the implementation of comprehensive lung cancer screening programs. To ensure safe, effective screening, hospitals may need to invest resources or coordinate care with facilities that can offer comprehensive care for screening through downstream evaluation and treatment of screen-detected cancers.

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Section: Original Researchmentioning

confidence: 99%

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

et al. 2016

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“…Three single-site cohort studies found that DAPs reduced lung cancer diagnosis wait times but provided few details to link outcomes with DAP characteristics 12–14. Another study, while not based on DAPs, evaluated service delivery among 4804 patients with lung cancer seen in 2007 at 131 Veterans Health Administration facilities, but also failed to identify facility-level attributes associated with better quality care 23. Therefore, this study was unique because it generated knowledge from multiple sites on the DAP characteristics that can improve teamwork and diagnostic service delivery.…”

Section: Discussionmentioning

confidence: 99%

How do organisational characteristics influence teamwork and service delivery in lung cancer diagnostic assessment programmes? A mixed-methods study

et al. 2017

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ObjectivesDiagnostic assessment programmes (DAPs) can reduce wait times for cancer diagnosis, but optimal DAP design is unknown. This study explored how organisational characteristics influenced multidisciplinary teamwork and diagnostic service delivery in lung cancer DAPs.DesignA mixed-methods approach integrated data from descriptive qualitative interviews and medical record abstraction at 4 lung cancer DAPs. Findings were analysed with the Integrated Team Effectiveness Model.Setting4 DAPs at 2 teaching and 2 community hospitals in Canada.Participants22 staff were interviewed about organisational characteristics, target service benchmarks, and teamwork processes, determinants and outcomes; 314 medical records were reviewed for actual service benchmarks.ResultsFormal, informal and asynchronous team processes enabled service delivery and yielded many perceived benefits at the patient, staff and service levels. However, several DAP characteristics challenged teamwork and service delivery: referral volume/workload, time since launch, days per week of operation, rural–remote population, number and type of full-time/part-time human resources, staff colocation, information systems. As a result, all sites failed to meet target benchmarks (from referral to consultation median 4.0 visits, median wait time 35.0 days). Recommendations included improved information systems, more staff in all specialties, staff colocation and expanded roles for patient navigators. Findings were captured in a conceptual framework of lung cancer DAP teamwork determinants and outcomes.ConclusionsThis study identified several DAP characteristics that could be improved to facilitate teamwork and enhance service delivery, thereby contributing to knowledge of organisational determinants of teamwork and associated outcomes. Findings can be used to update existing DAP guidelines, and by managers to plan or evaluate lung cancer DAPs. Ongoing research is needed to identify ideal roles for navigators, and staffing models tailored to case volumes.

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“…For example, in H ong K ong, despite the availability of EBUS service in most respiratory units of public hospitals, clinical practice varies from sampling only the FDG‐avid mediastinal lymph nodes only to systematic sampling . Performance including the thoroughness of staging and care provided may vary according to the characteristics of the healthcare facility such as academic affiliation, for‐profit status and staffing …”

Section: Lung Cancer Stagingmentioning

confidence: 99%

“…31 Performance including the thoroughness of staging and care provided may vary according to the characteristics of the healthcare facility such as academic affiliation, for-profit status and staffing. 30,32…”

Section: Variations and Disparities In Practicementioning

confidence: 99%

“…Not unlike the situation in other parts of the world, variations in practice, infrastructure, resource availability and standards of care for lung cancer are present across countries and also within the same countries in the Asia‐Pacific region. For example, in H ong K ong, despite the availability of EBUS service in most respiratory units of public hospitals, clinical practice varies from sampling only the FDG‐avid mediastinal lymph nodes only to systematic sampling .…”

Section: Lung Cancer Stagingmentioning

confidence: 99%

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Lung cancer staging now and in the future

et al. 2015

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For a long time lung cancer was associated with a fatalistic approach by healthcare professionals. In recent years, advances in imaging, improved diagnostic techniques and more effective treatment modalities are reasons for optimism. Accurate lung cancer staging is vitally important because treatment options and prognosis differ significantly by stage. The staging algorithm should include a contrast computed tomography (CT) of the chest and the upper abdomen including adrenals, positron emission tomography/CT for staging the mediastinum and to rule out extrathoracic metastasis in patients considered for surgical resection, endosonography-guided needle sampling procedure replacing mediastinoscopy for near complete mediastinal staging, and brain imaging as clinically indicated. Applicability of evidence-based guidelines for staging of lung cancer depends on the available expertise and level of resources and is directly impacted by financial issues. Considering the diversity of healthcare infrastructure and economic performance of Asian countries, optimal and costeffective use of staging methods appropriate to the available resources is prudent.The pulmonologist plays a central role in the multidisciplinary approach to lung cancer diagnosis, staging and management. Regional respiratory societies such as the Asian Pacific Society of Respirology should work with national respiratory societies to strive for uniform standards of care. For developing countries, a minimum set of care standards should be formulated.Cost-effective delivery of optimal care for lung cancer patients, including staging within the various healthcare systems, should be encouraged and most importantly,tobacco control implementation should receive an absolute priority status in all countries in Asia.

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Facility Characteristics and Quality of Lung Cancer Care in an Integrated Health Care System

Cited by 12 publications

References 27 publications

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

How do organisational characteristics influence teamwork and service delivery in lung cancer diagnostic assessment programmes? A mixed-methods study

Lung cancer staging now and in the future

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