Author of

• 11595

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  P2.07 - Poster Session 2 - Surgery (ID 190)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11623

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    P2.07-028 - ProvenCare®: Evidence Based Care to Optimize Lung Cancer Resection Outcomes (ID 2561)

    09:30 - 09:30  |  Author(s): M.A. Facktor
    • Abstract

    Background
    Lung cancer remains by far the biggest cause of cancer deaths worldwide, exceeding the next four cancers combined. Meanwhile, health systems struggle with ballooning costs and an unclear relationship between cost and outcomes. Within this context, there exists a great need for reliable, goal-oriented, and cost-effective care. ProvenCare[®] Lung Cancer is a national, multi-institutional care improvement collaborative that identifies and prescribes best practice elements of care in order to improve outcomes of pulmonary resection for lung cancer.

    Methods
    Incorporating principles of reliability science, the ProvenCare[® ]group established a protocol to promote adherence to and completion of best practice elements of care for patients undergoing pulmonary resection for lung cancer. Thirty-eight care elements span the continuum from preoperative assessment through intraoperative and inpatient postoperative care, and on to post-discharge follow-up. An original 6 thoracic surgical teams, subsequently expanded to twelve institutions, prospectively measured adherence to the prescribed elements of care in an “all or none” measure of success (adherence to all 38 elements is required for “compliance”). These data are to be compared both in a pre- and post-ProvenCare[®] involvement within participating sites, as well as to contemporaneous data within the Society of Thoracic Surgeons (STS) General Thoracic Database, to compare operative morbidity and mortality between the two groups. Figure 1

    Results
    To date, nearly 900 patients have been enrolled at the twelve Collaborative sites. Certain elements have proven more difficult than others to accomplish reliably, namely adherence to postoperative pain control and pulmonary toilet regimens. Even so, the redesign of the complex care required by the lung resection patient to embed evidence-based best practices into everyday patient flow, has resulted in high adherence to the prescribed elements of care, ranging from 92 to 100%. A comparison of the ProvenCare[®] study group to the STS Database control will be undertaken once an additional 200 patients are enrolled.

    Conclusion
    Quality and reliability represent frontiers of cancer care, and have the potential to improve patient outcomes as much as blockbuster medications or innovative radiation or surgical techniques, and perhaps more cost-effectively. We present an example of a national, collaborative, multidisciplinary model of reliable care that represents the first attempt to test patient care outcomes in this context.