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Imaging to Treatment: Leveraging Technology to Redesign Care for the Pulmonary Nodule Pathway


Ashish Patel, MD; Daniel Navarro, MD; Michael Rizzo, MD;
Steven Levine, MD; Todd Osinski, MD


Abstracts from the Kaiser Permanente 2018 National Quality Conference

From Northern California

Background: A 68-year-old woman came to Kaiser Permanente (KP) Oakland Emergency Department in 2006 for symptoms of bowel obstruction. Her hospital stay included a chest x-ray that showed an incidental lung nodule suspicious for cancer. She was treated for bowel obstruction, recovered, and went home. She returned 6 months later with shortness of breath and normal bowel function. Repeat chest x-ray showed a large mass consistent with advanced lung cancer.
Methods: A pilot study was started at KP Oakland in 2006 to see how we can improve our care for following-up abnormal lung nodules. All radiologists in the department were asked to flag any study that was suspicious of cancer. A medical assistant in the department kept the list and followed-up each patient to ensure the finding was addressed. Once the pilot demonstrated clinical need and patient benefit, the project was expanded to address the suspicious findings within 48 hours and support the primary care physician to expedite further work-up and treatment.
Results: Pilot: 650 patients (14/wk) were flagged with suspicious findings, of which 151 had cancer. Forty-eight patients (7%) were noted to have no intervention at 3 weeks, at which time the project intervened to ensure care. Expansion: 470 patients were followed. Of the 470 patients, 42 had cancer. The time from initial study, completion of the work-up, and seeing the treatment specialist was reduced from 40 days to 18 days.
Discussion: An effective program to follow incidental lung lesions was designed, tested, piloted, and spread to the entire KP Northern California Region by 2018. Our integrated technology tools allow radiologists to flag the study and the multidisciplinary care team members to take actionable steps in KP HealthConnect. Four centralized multidisciplinary teams (with pulmonologists, radiologists, thoracic surgeons, oncologists, and care coordinators) provide guidance to the primary care physician, on the basis of Comprehensive Cancer Network guidelines. The system provides a safety-net for new cancer diagnoses and expedites care for patients. The model is now being expanded for hepatobiliary, gastric, and adrenal cancer. This redesign in care, made possible by technology, will help us improve care for many more patients to come.

Abstracts from the Kaiser Permanente 2018 National Quality Conference


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