Application of Performance Improvement Methods to Improve Timeliness of Lung Cancer Care

Background/Aims: Timeliness, an essential element of high-quality care as defined by the Institute of Medicine, is critical in cancer care delivery. Timeliness of diagnosis and treatment is associated with improved outcomes for some cancers. A Kaiser Permanente Southern California (KPSC) organizational goal is to achieve optimal timeliness of cancer care to ensure best possible outcomes for KPSC members. Methods: A working group at the KPSC Los Angeles Medical Center (LAMC), led by the physician director of the cancer program, the director of performance improvement and the director of oncology services, convened a series of multidisciplinary meetings focused on improving timeliness of lung cancer care. Participants included LAMC physicians, nurses and administrators as well as KPSC researchers. Alignment of physician education time and education credits was facilitated by administrative leaders. Performance improvement activities included review of current state of LAMC lung cancer care, definition of key metrics, iterative development of specialty-based process maps, chart abstraction and identification of potential interventions. Physicians participated in all activities, facilitated by group leaders. Data sources included medical records and tumor registry data. Results: Review of LAMC baseline data for patients newly diagnosed with lung cancer in 2012 (N=60) showed that the median number of days from initial imaging to date of diagnosis is 21 days (range: 0–112). Median days from postdiagnosis physician consultation to initial treatment varied by physician specialty: 4 (radiology), 12 (radiation oncology), 24 (medical oncology) and 27 days (surgery). Chart review revealed that patients diagnosed in the inpatient setting had shorter time to receipt of services. Root cause analysis revealed several target areas for improvement interventions including: development of a lung cancer protocol for radiology, a closed-loop system with pulmonology, improved integration of palliative and hospice care, a rapid results system for genetic studies, and increased frequency of lung tumor board. A new position of lung cancer coordinator was proposed to oversee activities, and standardized “smart phrases” were created for documentation of encounters. Discussion: Multidisciplinary groups with clinician, performance improvement and research participation can achieve significant progress in identifying areas for improvement using robust methods. Next steps will include implementation and evaluation of the proposed improvements