Education, Teaching, and Quality Improvement |

Lung Nodule Care: A Multidisciplinary Approach to Triple Aim Care FREE TO VIEW

Kealy Ham; Randy Hurley; Melina Koch; Carol Muntean
Author and Funding Information

HealthPartners, Bloomington, MN

Chest. 2014;146(4_MeetingAbstracts):536A. doi:10.1378/chest.1991488
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SESSION TITLE: Quality & Clinical Improvement Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The purpose of this project was to evaluate the ability of a newly implemented systematized pathway to monitor, screen and treat patients with incidental lung nodule findings.

METHODS: This was a multi-specialty quality improvement project implemented within an integrated healthcare system (HealthPartners; Bloomington, MN) to assess and monitor benign lung nodules and rapidly diagnose and treat cancerous lung tumors. Following discovery of a lung nodule on any imaging procedure, an electronic order is placed in the integrated EMR to the Lung Nodule Clinic. A nurse practitioner and physician team completes standardize risk assessment tools and reviews patient history and physical findings for the probability for malignancy through a mix of virtual monitoring and in-person visits. Low-risk patients (tumor size < 8mm) are monitored via registry and outreach occurs proactively for education and coordination of their follow-up treatment plan. High risk patients (tumors > 8mm and/or presence of multiple risk factors) undergo further testing (bronchoscopy, EBUS, or TBNA) and simultaneous coordination with oncology and thoracic surgery teams occurs. Preferential access is granted to these patients to decrease wait times for visits and intervention. Patient data was tracked via registry and are descriptively reported.

RESULTS: In 2013, there were a total of 314 patients entered into the Lung Nodule treatment pathway. Between 8/1/2012-7/31/2013, a total of 151 new cases of lung cancer (42.4% 3A or below) were identified within our total patient population, which is slightly higher than the population national average reported by NCI (37%).

CONCLUSIONS: Early qualitative results suggest this program may be influencing the rate of early identification of cancer in our system. More study is necessary to compare the quantitative experience of patients in the Lung Nodule Pathway in diagnosis, staging, patient experience, and total cost of care against patients treated outside of this pathway.

CLINICAL IMPLICATIONS: The clinical implications at this stage of the analysis are weighted more toward patient experience through timely care and the qualitative assumptions that early diagnosis and intervention will have benefits in long term survival.

DISCLOSURE: The following authors have nothing to disclose: Kealy Ham, Randy Hurley, Melina Koch, Carol Muntean

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