Building a Multidisciplinary Bridge Across the Quality Chasm in Thoracic Oncology
Raymond U. Osarogiagbon, MD
Baptist Memorial Hospital-Tipton
Improving Healthcare Systems
The Building a Multidisciplinary Bridge Across the Quality Chasm in Thoracic Oncology project will examine the effectiveness of a coordinated multidisciplinary model of treatment for thoracic oncology at a regional hospital system. Baptist Memorial Health Care offers a full continuum of care to communities throughout the MidSouth that have the highest lung cancer incidence and death rates in the country. Lung cancer rates in this area reflect the disease’s socioeconomic disparity, disproportionately affecting low-income people, African-Americans, and both rural and inner-city inhabitants. Low lung cancer survival rates are thought to be partially due to the failure of the traditional serial model of care, in which multiple specialists independently screen, diagnose, and treat the patient through a sequence of referrals. This model can result in poor patient outcomes as a result of inconsistency, inefficiency (duplication and incompleteness), non-timeliness, and a lack of oversight. In addition, the model presents barriers to access for disadvantaged patients and limits opportunities for direct patient input. With PCORI funding, we propose to rigorously test the comparative impact of a multidisciplinary care model, in which key specialists concurrently provide early input and execute a consensus plan of care developed in collaboration with patients and their families, who will be the ultimate beneficiaries of this research project. Potential improvement in patient outcomes will result in more timely heathcare delivery, a higher rate of stage-appropriate treatment, and more direct patient involvement in decision making. Our objective is to provide high-level evidence of the comparative impact of multidisciplinary care on patient outcomes. The key research method will be a matched cohort comparative effectiveness study of patients receiving serial versus multidisciplinary care. Model design will incorporate input from a series of patient/stakeholder surveys and focus groups and use computer simulation modeling to optimize the efficiency of patient flow. We will measure patient-centered endpoints including survival, satisfaction with the medical care experience, timeliness and appropriateness of care, and quality of staging. Significantly, the study will be one of the first to explore the multidisciplinary care model in a regional hospital system. Although the model is strongly advocated by experts and clinical practice guidelines, there are few examples of successful implementation, mostly in academic tertiary care centers. Findings will broadly apply to any complex healthcare delivery environment in which multiple specialists manage patients with complex, debilitating, and life-threatening health problems.