Hospital Characteristics Associated with Timeliness of Care in Veterans with Lung Cancer

Schultz, Ellen; Powell, Adam A.; McMillan, Alex; Olsson, Julie; Enderle, Mark A.; Graham, Barry A.; Ordin, Diana L.; Gould, Michael K.

doi:10.1164/rccm.200806-890oc

Cited by 42 publications

(41 citation statements)

References 17 publications

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“…Well-established arrangements are already in place for veterans with non-screen-detected cancers to receive PET scan and radiation oncology services at nearby non-VA facilities, which may obviate the need to have these services available on site. Indeed, the presence of these infrastructure elements on site did not correlate with timeliness of lung cancer care in a prior national VA study (29). If the CHEST/ATS policy recommendation for on-site PET scanners and radiation oncologists were waived, then almost one-half (44%) of facilities would be categorized as ready for immediate screening implementation.…”

Section: Original Researchmentioning

confidence: 95%

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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: 95%

“…outcomes if appropriate referral pathways are in place to ensure timeliness and quality of lung cancer care (29,30).…”

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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“…2,3 Little is known about the time interval from diagnosis to cancer-directed treatment at VAMCs. When examining lung cancer at VA hospitals using international studies as a comparison group, Schultz et al 4 concluded that wait times were comparable at VA and non-VA centers based on historical controls (median, 22 v 24 days, respectively). Similarly, the VA Office of Quality and Performance did not estimate a considerable difference in the timeliness of treatment of patients with colorectal cancer.…”

Section: Introductionmentioning

confidence: 99%

Efficiency of Colorectal Cancer Care Among Veterans: Analysis of Treatment Wait Times at Veterans Affairs Medical Centers

Merkow

Bilimoria

Sherman

et al. 2013

JOP

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Purpose: Timeliness of cancer treatment is an important aspect of health care quality. Veterans Affairs Medical Centers (VAMCs) are expected to treat a growing number of patients with cancer. Our objectives were to examine treatment times from diagnosis to first-course therapy for patients with colon and rectal cancers and assess factors associated with prolonged wait times. Methods:From the VA Central Cancer Registry, patients who underwent colon or rectal resection for cancer from 1998 to 2008 were identified. Time from diagnosis to definitive cancer-directed therapy was measured, and multivariable regression methods were used to determine predictors of prolonged wait times for colon (Ն 45 days) and rectal (Ն 60 days) cancers.

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“…Schultz EM et al examine the effect that institutional structures and processes of care have on delay, but the results are unequivocal [24]. Another study showed that the higher the number of hospitals visited before confirmed diagnosis the longer the delay [25].…”

Section: Discussionmentioning

confidence: 99%

Transfer between hospitals as a predictor of delay in diagnosis and treatment of patients with Non-Small Cell Lung Cancer – a register based cohort-study

Iachina

Jakobsen

Fallesen

et al. 2017

BMC Health Serv Res

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BackgroundLung cancer is the second most frequent cancer diagnosis in Denmark. Although improved during the last decade, the prognosis of lung cancer is still poor with an overall 5-year survival rate of approximately 12%. Delay in diagnosis and treatment of lung cancer has been suggested as a potential cause of the poor prognosis and as consequence, fast track cancer care pathways were implemented describing maximum acceptable time thresholds from referral to treatment. In Denmark, patients with lung cancer are often transferred between hospitals with diagnostic facilities to hospitals with treatment facilities during the care pathway. We wanted to investigate whether this organizational set-up influenced the time that patients wait for the diagnosis and treatment. Therefore, the objective of this study was to uncover the impact of transfer between hospitals on the delay in the diagnosis and treatment of Non-Small Cell Lung Cancer (NSCLC).MethodsWe performed a historical prospective cohort study using data from the Danish Lung Cancer Registry (DLCR). All patients diagnosed with primary NSCLC from January 1st 2008 to December 31st 2012 were included. Patients with unresolved pathology and incomplete data on the dates of referral, diagnosis and treatment were excluded.ResultsA total of 11 273 patients were included for further analyses. Transfer patients waited longer for treatment after the diagnosis, (Hazard ratio (HR) 0.81 (0.68–0.96)) and in total time from referral to treatment (HR 0.84 (0.77–0.92)), than no-transfer patients. Transfer patients had lower odds of being diagnosed (Odds Ratio (OR) 0.82 (0.74–0.94) and treated (OR 0.66 (0.61–0.72) within the acceptable time thresholds described in the care pathway.ConclusionFast track cancer care pathways were implemented to unify and accelerate the diagnosis and treatment of cancer. We found that the transfer between hospitals during the care pathway might cause delay from diagnosis to treatment as well as in the total time from referral to treatment in patients with Non Small-Cell Lung Cancer. The difference between no-transfer and transfer patients persists after adjusting for known predictors of delay.

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Hospital Characteristics Associated with Timeliness of Care in Veterans with Lung Cancer

Cited by 42 publications

References 17 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

Efficiency of Colorectal Cancer Care Among Veterans: Analysis of Treatment Wait Times at Veterans Affairs Medical Centers

Transfer between hospitals as a predictor of delay in diagnosis and treatment of patients with Non-Small Cell Lung Cancer – a register based cohort-study

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