The Victorian Lung Cancer Service Redesign Program (VLCSRP) was established in 2016 to assist hospitals to develop systems and measures that target improvements in the timeliness of lung cancer care. Five pilot projects were conducted in health services across Victoria. The application of service redesign, quality improvement and standardised data capture technologies on timeliness of lung cancer care were explored.
Redesign technologies were used to create current and anticipated performance site maps. Local redesign solutions were developed, tested and refined using Plan-Do-Study-Act (PDSA) cycle metrics. The Victorian Lung Cancer Registry was engaged to prospectively collect quantitative data from sites using a web based portal. Summary statistics and time series analysis were performed to analyse indicator performance over a six-month period of observation pre-implementation (n=205) and a six-month period of local intervention implementation (n=224). Funnel plots were used to benchmark site indicator performance during the six-month implementation period.
Subjects in the implementation period were younger (p=0.003), more likely to be born in Australia (p=0.029) and to receive chemotherapy (p=0.045). There was a substantive reduction in time from referral to first specialist appointment across all sites with interval falling from a median of 6.0 (0.0-15.0) to 4.0 (1.0-10.0) days. The proportion seen by a specialist within 14 days increased from 74.3% to 84.2% across all sites. The proportion of subjects with documented presentation to the MDM increased from 61% to 67%. A high proportion (>80%) of subjects underwent first staging test within 14 days of specialist appointment in both the pre-implementation and implementation periods. The interval between diagnosis to treatment was not substantively changed in the 6-month implementation period.
The use of modern health service redesign and quality improvement technologies enables identification and analysis of clinical practice variation and may be utilised to enhance timeliness of cance