CERTAIN’s Lung Cancer Quality Improvement Collaborative was developed out of work on the Collaborative to Improve Native Cancer Outcomes (CINCO)—a National Cancer Institute project funded to improve cancer health outcomes and quality of life specifically for American Indian and Alaskan Native patient populations. Fifteen thoracic surgeons, one pulmonologist, and four advanced practice clinicians from five institutions within Washington State are currently working together to improve the quality and value of thoracic oncologic care. These clinicians and hospitals account for over half the state’s volume of lung cancer surgery.
The collaborative's first priority was to better understand the landscape of lung cancer surgery across the state’s hospitals. They found that the number of hospitals performing lung cancer surgery was decreasing over time with a shift in care from low-volume hospitals to medium- and higher-volume hospitals. These findings mirror those from several national studies. Despite this shift in care, there remained considerable variation in outcomes and costs across hospitals within the state. Furthermore, an analysis of outcomes and costs revealed that the value of care also varied across hospitals.
The group has concluded that there are certain essential components of a regional quality improvement initiative. First, all hospitals should participate in a recognized national quality improvement initiative without attempts to alter standardized definitions, validated risk-adjustment strategies, or vetted outcomes metrics. Clinicians and hospitals in this collaborative all participate in the Society of Thoracic Surgeons General Thoracic Database, and they recommend that hospitals performing lung cancer surgery in Washington State also participate in this database. Participation in this clinical registry allows for comparisons to national benchmarks and efficient use of precious resources for quality improvement initiatives. Second, quality improvement requires engagement of all relevant stakeholders, including but not limited to patients, clinicians, hospitals, insurers, and employers. Quality improvement interventions that provide value to multiple stakeholders are most likely to make a significant impact. For instance, after engaging patients, clinicians, and hospital administrators, the collaborative has embarked on a project to reduce hospital length of stay after lobectomy without increasing 30-day readmissions. Without demonstration of value, quality improvement efforts are unlikely to be sustainable. Third, all of these efforts must occur in the context of a community bound together by common goals, trust, and a willingness to share ideas, experiences, perspectives, and information. The collaboration between these clinicians and hospitals is emblematic of what can be achieved across the entire state of Washington.
To learn more about CERTAIN's regional Lung Cancer Quality Improvement Collaborative, or to find out how to get involved, contact CERTAIN.