Reducing Disparities in the Care of Patients with Lung Cancer
A program created by a physician at The MetroHealth System allows clinicians to more quickly identify patients at high risk of lung cancer and improve their access to expedited diagnosis and care.
An article published online this month in the journal Clinical Lung Cancer details how a rapid outpatient diagnostic program (RODP), consisting of a team of clinicians and software that supports their work, reduced racial disparities in accessing follow-up care for patients referred to a pulmonary doctor based on abnormal X-ray or CT results.
The program analyzed electronic referrals of high-risk patients and presented data to a lung cancer specialist in a way that allowed them to rapidly assess and drive the next best steps for each patient.
Using robust statistical analysis that accounts for trends over time, the research team found significant improvements in the rates of timely patient referral completions in the two years after the introduction of the program when compared to the two years prior.
Clear racial disparities in the timely completion of referrals that existed before the program were substantially reduced, with the biggest improvements in outcomes seen in racial and ethnic minority individuals. Those patients also waited less time to be evaluated by a specialist and received specialized imaging tests and biopsies faster after the introduction of the program.
“We developed new technology that helped quickly identify which of the thousands of patients who are referred to pulmonary specialists could have lung cancer, then we built a clinical team around the program to proactively work on guiding patients through the next steps of their evaluation as expeditiously as possible,” said program creator and senior author Yasir Tarabichi, MD, Director of Clinical Research Informatics at MetroHealth.
The result of helping all patients navigate a frightening and potentially complex health concern, Dr. Tarabichi said, was more equitable access to health care.
“Complexity in the health care system is a well-established barrier and a driver of disparities in access and health,” he said. “In the pre-program world, patients had to call and schedule appointments themselves for that next step in their evaluation. They often had to delay for personal reasons or got flustered trying to figure things out on their own. Add to that the possibility that ‘this could be lung cancer,’ and it’s even more frightening and confusing.”
“The diagnosis of lung cancer is made challenging by complex diagnostic decisions, procedures and the need for multiple specialist consultations,” said Ismini Kourouni, MD, lead author and Director of Thoracic Diagnostics at MetroHealth. “The software allowed a rapid specialist-driven assessment of abnormal lung scans of our patients and created a platform that empowered efficient workup, multidisciplinary communication and care coordination.”
Katherine Dutton, Clinical Practice Coordinator for MetroHealth’s Division of Pulmonary Medicine, engages patients during the evaluation and works to keep them on track, informed and connected to their care.
“Many people have at least one challenge, and sometimes multiple barriers to receiving care, including transportation, financial constraints, level of health literacy, computer access and family responsibilities,” she said. “Everyone needs to be helped according to their specific situation. It helps to tease out which barriers to care need to be addressed.”
As the direct point of contact for patients, “Our nurse coordinator minimizes the possibility that a vulnerable patient will be lost during the process,” said Dr. Kourouni.
Lung cancer is often discovered in the late stages of the disease, and earlier detection and diagnosis are key to survival. “Lung cancer is a silent killer that can spread without causing any symptoms until it’s advanced,” said Dr. Kourouni. “Improving lung cancer outcomes is dependent on early detection and rapid access to the right care. The earlier it is caught, the better for patients who can then start treatment with the hope for cure.”
The program was built to be easily mirrored by other health care systems.
“Through this effort, we have been able to combat what can often feel like insurmountable disparities in access,” Dr. Tarabichi said. “We are able to level the playing field and provide access to high quality care for all patients.”
Founded in 1837, MetroHealth is leading the way to a healthier you and a healthier community through service, teaching, discovery, and teamwork. Cuyahoga County’s public, safety-net hospital system, MetroHealth meets people where they are, providing care through four hospitals, four emergency departments, and more than 20 health centers and 40 additional sites. Each day, our 8,000 employees focus on providing our community with equitable health care–through patient-focused research, access to care, and support services–that seeks to eradicate health disparities rooted in systematic barriers. For more information, visit metrohealth.org.