Development of a Novel Lung Cancer Quality Improvement Collaborative in Illinois

Lung cancer is the leading cause of cancer-related death in the United States with an incidence of 221,200 new cases and 158,040 deaths annually.1 Prior studies from our group and other investigators have demonstrated that guideline-concordant care is still generally poor for malignant diseases with adherence rates as low as 40-60%.2-7 Lung cancer care guidelines are multifaceted and complex: once a diagnosis of cancer is made, the patient typically undergoes a battery of diagnostic tests, staging studies, and specialist referrals prior to the initiation of treatment. Treatment is multidisciplinary and may involve multiple therapies including surgery, chemotherapy, and/or radiotherapy. Yet, robust, comprehensive metrics for the assessment of guideline-concordant care in lung cancer have not yet been developed. Both overutilization and underutilization have been documented in cancer care, in areas such as pretreatment staging, treatment, and post-treatment surveillance for surgical, medical, and radiation oncology. Our group has published extensively regarding national and local adherence to guidelines for numerous malignancies, and we have particular expertise in developing, testing, and implementing cancer quality measures.8-28 However, despite lung cancer’s notable prevalence, considerable complexity, and tremendous costs, few measures of quality of care are available for lung cancer and little information exists regarding rates of guideline-concordant care. Further, improved assessment of quality cancer care delivery has been identified as an area of emphasis by the National Cancer Institute and the American Society of Clinical Oncology. This application proposes to develop valid, meaningful quality measures for lung cancer care through a formal international multidisciplinary expert panel consensus process. Then, adherence with these new measures will be assessed to examine the quality of lung cancer care in Illinois hospitals through the Illinois Cancer Quality Collaborative through formation of an Illinois Lung Cancer Collaborative (ILCC). Hospitals with poor performance on the metrics will be assessed to understand the local contextual factors that explain the worse-than-expected adherence to guidelines and to identify barriers to adherence. Based on our prior similar experiences, we will then develop a lung cancer care quality toolkit to improve adherence with the quality measures consisting of educational (physician, nurse, patient), multidisciplinary evaluation (enhancing tumor boards), and cultural interventions. The ultimate goal of the proposal is improve quality and decrease variability in lung cancer care throughout Illinois. We expect to develop a scalable toolkit that can be used throughout the United States. Aim 1: Develop valid lung cancer quality-of-care measures using a modified-Delphi process based on a multi-institutional, multidisciplinary panel of experts. H1: Adherence to consensus-derived quality-of-care measures in the staging, treatment, and surveillance of patients with lung cancer will be variable among hospitals and patient populations. Aim 2: Assess patient- and hospital-level adherence with these quality measures at 12 hospitals participating in an Illinois Lung Cancer Collaborative. H2: Adherence to consensus-derived quality-of-care measures in the staging, treatment, and surveillance of patients with lung cancer will be variable among hospitals and patient populations. Aim 2: Identify barriers and facilitators to adherence with lung cancer quality-of-care measures at 12 diverse