N/A N=781

Building a Multidisciplinary Bridge Across the Quality Chasm in Thoracic Oncology

Lung Cancer

Bottom Line

View on ClinicalTrials.gov: NCT02123797 ↗

Enrolled (actual)

781

Serious AEs

—

Results posted

Jul 2020

Primary outcome: Primary: Thoroughness of Invasive Staging, Multidisciplinary (MD) vs Serial Care (SC) — 108; 168; 70; 180 Participants — p=0.0007

Study Design & Population

Study type: Observational
Phase: N/A
Interventions: —
Age: Pediatric, Adult, Older Adult
Sex: All
Sponsor: Baptist Memorial Health Care Corporation
Primary completion: Oct 2017

Outcome Measures

Outcome	Result	p-value
PRIMARY Thoroughness of Invasive Staging, Multidisciplinary (MD) vs Serial Care (SC)	108; 168; 70; 180	0.0007 sig
PRIMARY Thoroughness of Invasive Mediastinal Staging, MD vs SC	91; 126; 87; 222	0.0022 sig
PRIMARY Thoroughness of Bi-Modal Staging Practice, MD vs SC	161; 267; 17; 81	0.0004 sig
PRIMARY Thoroughness of Tri-Modal Staging Practice, MD vs SC	99; 132; 79; 216	<0.0001 sig
PRIMARY Thoroughness of Invasive Staging, MD vs SC (Conference) vs SC (no Conference)	108; 46; 122; 70; 30; 150	0.0366 sig
PRIMARY Thoroughness of Invasive Mediastinal Staging, MD vs SC (no Conference) vs SC (Conference)	91; 40; 86; 87; 36; 186	0.0703
PRIMARY Thoroughness of Bi-Modal Staging Practice, MD vs SC (Conference) vs SC (no Conference)	161; 62; 205; 17; 14; 67	0.0010 sig
PRIMARY Thoroughness of Tri-Modal Staging Practice, MD vs SC (Conference) vs SC (no Conference)	99; 39; 93; 79; 37; 179	0.0055 sig
PRIMARY Stage-Appropriateness Treatment Selection, MD vs SC	140; 232; 33; 106	0.0045 sig
PRIMARY Stage-Appropriateness Treatment Selection, MD vs SC (Conference) vs SC (no Conference)	140; 58; 174; 33; 15; 91	0.0474 sig
PRIMARY Timeliness of Communication, MD vs SC(Conference)	168; 74; 242; 10; 2; 12	—
PRIMARY Concordance Rate for Initial Conference Recommendations, MD vs SC (Conference)	140; 45; 37; 30	0.0014 sig
PRIMARY Concordance Rate for Initial Conference Recommendation(s) With Prior Condition Met, MD vs SC (Conference)	145; 49; 32; 26	0.0019 sig
PRIMARY Concordance Rate for Any Conference Recommendation, MD vs SC (Conference)	174; 71; 3; 4	0.0499 sig
PRIMARY Overall Concordance Rate Using a Hierarchy of Initial Conference Recommendations, MD vs SC (Conference)	158; 60; 19; 15	0.0263 sig
PRIMARY Concordance Rate for Treatment Recommendations With Prior Recommendations Completed, MD vs SC (Conference)	87; 38; 14; 8	0.1503
PRIMARY Baseline Patient Survey Response Rate, MD vs SC	156; 306; 22; 42	—
PRIMARY 3-month Patient Survey Response Rate, MD vs SC	99; 189; 57; 117	—
PRIMARY 6-Month Patient Survey Response Rate, MD vs SC	101; 178; 55; 128	—
PRIMARY Patient Survey Scores at Baseline, MD vs SC	3.28; 3.15; 5.32; 5.23; 0.92; 1.14	—
PRIMARY Patient Survey Scores at 3 Months, MD vs SC	3.31; 3.30; 5.25; 5.11; 0.93; 1.17	—
PRIMARY Patient Survey Scores at 6 Months, MD vs SC	3.36; 3.15; 5.48; 5.06; 1.15; 1.09	—
PRIMARY Baseline Caregiver Survey Response Rate, MD vs SC	100; 144; 0; 0	—
PRIMARY 3-month Caregiver Survey Response Rate, MD vs SC	50; 62; 50; 82	—
PRIMARY 6-Month Caregiver Survey Response Rate, MD vs SC	34; 31; 66; 113	—
PRIMARY Caregiver Survey Scores at Baseline, MD vs SC	3.27; 3.14; 0.78; 0.90; 0.94; 1.03	—
PRIMARY Caregiver Survey Scores at 3 Months, MD vs SC	3.32; 3.55; 0.71; 1.08; 0.90; 1.00	—
PRIMARY Caregiver Survey Scores at 6 Months, MD vs SC	3.24; 3.23; 1.05; 0.91; 1.05; 0.88	—
PRIMARY Timeliness of Care, MD vs SC	25; 15; 20; 16; 29; 20	0.0042 sig
PRIMARY Timeliness of Care, MD vs SC (Conference) vs SC (no Conference)	25; 18.5; 13; 20; 18; 16	0.0146 sig
PRIMARY Clinical Provider Survey Responses - Ease of Referring Patients to the Conference	9; 7; 5; 2; 1; 0	—
PRIMARY Clinical Provider Survey Responses - How Quickly my Patients Get Scheduled to be Discussed at the Conference	10; 7; 5; 1; 1; 0	—
PRIMARY Clinical Provider Survey Responses - The Helpfulness of the Staff in Scheduling Patients	10; 8; 5; 1; 0; 0	—
PRIMARY Clinical Provider Survey Responses - The Quality of Treatment Recommendations That I Received for my Patient	10; 6; 5; 1; 2; 0	—
PRIMARY Clinical Provider Survey Responses - How Quickly I Receive Feedback on my Patient	10; 7; 5; 1; 1; 0	—
PRIMARY Clinical Provider Survey Responses - The Consistency With Which my Patients Are Sent Back for Further Treatment	10; 7; 5; 0; 0; 0	—
PRIMARY Patient Overall Survival	0.58; 0.60; 0.34; 0.36	0.7506
PRIMARY Patient Overall Survival With SC Further Broken Down	0.58; 0.64; 0.58; 0.34; 0.41; 0.34	0.4847
PRIMARY Patient Disease/Progression Free Survival	0.45; 0.48; 0.26; 0.26	0.9874
PRIMARY Patient Disease/Progression Free Survival With SC Further Broken Down	0.45; 0.55; 0.46; 0.26; 0.32; 0.24	0.5377

Summary

Lung cancer kills 160,000 patients annually; this represents 28% of all US cancer deaths. The overall year survival rate has only improved from 12% to 17% in 33 years. This failure reflects the innate lethality of lung cancer, but also reflects defects in patient care delivery. Care for the lung cancer patient starts with an abnormal radiologic scan, proceeds through a diagnostic biopsy, tests to determine the extent of spread of the disease (stage), selection of appropriate treatment, and finally ends with patient outcomes. At each step are multiple options and independent specialists, each one engaged by a process of sequential referrals in the serial care model. This process is often not user-friendly, is riddled with inefficiency, delays, and outcome variances. The coordinated multidisciplinary model, in which patients and their doctors collaborate to provide evidence-based care, is believed by experts to be superior, but has few examples of successful implementation. The implementation gap exists because of the paucity of good quality data, and lack of implementation know-how. Embedded in the highest US lung cancer mortality zone, the greater Memphis area has a racially, culturally, economically and geographically diverse population. The investigators research group has shown how poor quality care impairs patient survival in this region and in the greater US. The investigators have linked patient survival to compliance with multidisciplinary care plans. In this project, the investigators propose to rigorously test the impact of the multidisciplinary care model on patient outcomes in a community-based, private practice environment, similar to where 70% of lung cancer care is delivered in the US. The objective of this study is to provide high-level evidence of the impact of multidisciplinary care on lung cancer patient outcomes. Multidisciplinary care is defined as a model of care in which patients, their care-givers and key specialists concurrently and directly evaluate the same patients in the presence of the patients and their informal caregivers, in order to develop evidence-based consensus care plans

Eligibility Criteria

Inclusion Criteria

All patients who undergo care for lung cancer or an undiagnosed lung mass within the Baptist Memorial Health Care Corporation's hospitals from January 1, 2009 until the end of the defined study period will be eligible for inclusion in the data collection for this study. In addition, caregivers of patients within the same institution and within the study window, clinical care providers (doctors and nurses) who have taken care of patients within the eligible institutions during the study window.

Exclusion Criteria

Patients who do not have a radiology-identified lung lesion or lung cancer are excluded from this study.
Patients not receiving care within the Baptist Memorial Healthcare Corporation are excluded from this study.

View full record on ClinicalTrials.gov →

Data sourced from ClinicalTrials.gov (NCT02123797). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.