Regional Process Redesign of Lung Cancer Care: a Learning Health System Pilot Project

Overview

Journal Curr Oncol

Publisher MDPI

Specialty Oncology

Date 2018 Mar 7

PMID 29507485

Citations 28

Authors

M Fung-Kee-Fung

D E Maziak

J R Pantarotto

J Smylie

L Taylor

T Timlin

T Cacciotti

P J Villeneuve

C Dennie

C Bornais

S Madore

J Aquino

P Wheatley-Price

R S Ozer

D J Stewart

Affiliations

Soon will be listed here.

Abstract

Background: The Ottawa Hospital (toh) defined delay to timely lung cancer care as a system design problem. Recognizing the patient need for an integrated journey and the need for dynamic alignment of providers, toh used a learning health system (lhs) vision to redesign regional diagnostic processes. A lhs is driven by feedback utilizing operational and clinical information to drive system optimization and innovation. An essential component of a lhs is a collaborative platform that provides connectivity across silos, organizations, and professions.

Methods: To operationalize a lhs, we developed the Ottawa Health Transformation Model (ohtm) as a consensus approach that addresses process barriers, resistance to change, and conflicting priorities. A regional Community of Practice (cop) was established to engage stakeholders, and a dedicated transformation team supported process improvements and implementation.

Results: The project operationalized the lung cancer diagnostic pathway and optimized patient flow from referral to initiation of treatment. Twelve major processes in referral, review, diagnostics, assessment, triage, and consult were redesigned. The Ottawa Hospital now provides a diagnosis to 80% of referrals within the provincial target of 28 days. The median patient journey from referral to initial treatment decreased by 48% from 92 to 47 days.

Conclusions: The initiative optimized regional integration from referral to initial treatment. Use of a lhs lens enabled the creation of a system that is standardized to best practice and open to ongoing innovation. Continued transformation initiatives across the continuum of care are needed to incorporate best practice and optimize delivery systems for regional populations.

Citing Articles

Digital Information Ecosystems in Modern Care Coordination and Patient Care Pathways and the Challenges and Opportunities for AI Solutions.

Chen Y, Lehmann C, Malin B J Med Internet Res. 2024; 26:e60258.

PMID: 39622048 PMC: 11650087. DOI: 10.2196/60258.

The California collaborative network to promote data driven care and improve outcomes in early psychosis (EPI-CAL) project: rationale, background, design and methodology.

Tryon V, Nye K, Savill M, Loewy R, Miles M, Tully L BMC Psychiatry. 2024; 24(1):800.

PMID: 39543502 PMC: 11566177. DOI: 10.1186/s12888-024-06245-6.

Building a learning health care community in rural and remote areas: a systematic review.

Asghari S, Bent J, Modir A, MacDonald A, Farrell A, Bethune C BMC Health Serv Res. 2024; 24(1):1013.

PMID: 39223608 PMC: 11370021. DOI: 10.1186/s12913-024-11194-7.

Diversity in Combating Complex, Chronic, and Costly Conditions Using a Learning Health System Approach: A Scoping Review.

Davis R, Sine K, Burguera-Couce E, Ahmad J, Oliver B Perm J. 2024; 28(3):245-261.

PMID: 39113492 PMC: 11404638. DOI: 10.7812/TPP/24.012.

Tools and frameworks for evaluating the implementation of learning health systems: a scoping review.

Rajit D, Reeder S, Johnson A, Enticott J, Teede H Health Res Policy Syst. 2024; 22(1):95.

PMID: 39107779 PMC: 11302020. DOI: 10.1186/s12961-024-01179-7.

References

Gotfrit J, Zhang T, Zanon-Heacock S, Wheatley-Price P . Patients With Advanced Non-Small Cell Lung Cancer Requiring Inpatient Medical Oncology Consultation: Characteristics, Referral Patterns, and Outcomes. Clin Lung Cancer. 2016; 17(4):292-300. DOI: 10.1016/j.cllc.2015.12.011. View

Schilsky R, Michels D, Kearbey A, Yu P, Hudis C . Building a rapid learning health care system for oncology: the regulatory framework of CancerLinQ. J Clin Oncol. 2014; 32(22):2373-9. DOI: 10.1200/JCO.2014.56.2124. View

Margolis P, Peterson L, Seid M . Collaborative Chronic Care Networks (C3Ns) to transform chronic illness care. Pediatrics. 2013; 131 Suppl 4:S219-23. PMC: 4075135. DOI: 10.1542/peds.2012-3786J. View

Parry G, Carson-Stevens A, Luff D, McPherson M, Goldmann D . Recommendations for evaluation of health care improvement initiatives. Acad Pediatr. 2013; 13(6 Suppl):S23-30. DOI: 10.1016/j.acap.2013.04.007. View

Fung-Kee-Fung M, Goubanova E, Sequeira K, Abdulla A, Cook R, Crossley C . Development of communities of practice to facilitate quality improvement initiatives in surgical oncology. Qual Manag Health Care. 2008; 17(2):174-85. DOI: 10.1097/01.QMH.0000316995.79167.be. View

Ellis P, Vandermeer R . Delays in the diagnosis of lung cancer. J Thorac Dis. 2012; 3(3):183-8. PMC: 3256519. DOI: 10.3978/j.issn.2072-1439.2011.01.01. View

Walker J, Carayon P . From tasks to processes: the case for changing health information technology to improve health care. Health Aff (Millwood). 2009; 28(2):467-77. DOI: 10.1377/hlthaff.28.2.467. View

Brainard J, Hunter P . Do complexity-informed health interventions work? A scoping review. Implement Sci. 2016; 11(1):127. PMC: 5029105. DOI: 10.1186/s13012-016-0492-5. View

Brule S, Al-Baimani K, Jonker H, Zhang T, Nicholas G, Goss G . Palliative systemic therapy for advanced non-small cell lung cancer: Investigating disparities between patients who are treated versus those who are not. Lung Cancer. 2016; 97:15-21. DOI: 10.1016/j.lungcan.2016.04.007. View

10.

Abernethy A . Demonstrating the learning health system through practical use cases. Pediatrics. 2014; 134(1):171-2. DOI: 10.1542/peds.2014-1182. View

11.

Dekker A, Vinod S, Holloway L, Oberije C, George A, Goozee G . Rapid learning in practice: a lung cancer survival decision support system in routine patient care data. Radiother Oncol. 2014; 113(1):47-53. PMC: 5119278. DOI: 10.1016/j.radonc.2014.08.013. View

12.

Dixon-Woods M, McNicol S, Martin G . Ten challenges in improving quality in healthcare: lessons from the Health Foundation's programme evaluations and relevant literature. BMJ Qual Saf. 2012; 21(10):876-84. PMC: 3461644. DOI: 10.1136/bmjqs-2011-000760. View

13.

Olsson J, SCHULTZ E, Gould M . Timeliness of care in patients with lung cancer: a systematic review. Thorax. 2009; 64(9):749-56. DOI: 10.1136/thx.2008.109330. View

14.

Friedman C, Rubin J, Brown J, Buntin M, Corn M, Etheredge L . Toward a science of learning systems: a research agenda for the high-functioning Learning Health System. J Am Med Inform Assoc. 2014; 22(1):43-50. PMC: 4433378. DOI: 10.1136/amiajnl-2014-002977. View

15.

Racz J, Holloway C, Huang W, Hong N . Improving patient flow and timeliness in the diagnosis and management of breast abnormalities: the impact of a rapid diagnostic unit. Curr Oncol. 2016; 23(3):e260-5. PMC: 4900846. DOI: 10.3747/co.23.3017. View

16.

Greenhalgh T, Macfarlane F, Barton-Sweeney C, Woodard F . "If we build it, will it stay?" A case study of the sustainability of whole-system change in London. Milbank Q. 2012; 90(3):516-47. PMC: 3479382. DOI: 10.1111/j.1468-0009.2012.00673.x. View

17.

Wesorick B, Doebbeling B . Lessons from the field: the essential elements for point-of-care transformation. Med Care. 2011; 49 Suppl:S49-58. DOI: 10.1097/MLR.0b013e3182239331. View

18.

Etheredge L . A rapid-learning health system. Health Aff (Millwood). 2007; 26(2):w107-18. DOI: 10.1377/hlthaff.26.2.w107. View

19.

Fung-Kee-Fung M, Boushey R, Watters J, Morash R, Smylie J, Morash C . Piloting a regional collaborative in cancer surgery using a "community of practice" model. Curr Oncol. 2014; 21(1):27-34. PMC: 3921028. DOI: 10.3747/co.21.1663. View

20.

Santibanez P, Chow V, French J, Puterman M, Tyldesley S . Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency's ambulatory care unit through simulation. Health Care Manag Sci. 2010; 12(4):392-407. DOI: 10.1007/s10729-009-9103-1. View