Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland, OH.
Division of Pulmonary, Critical Care and Sleep Medicine, MetroHealth, Cleveland, OH; School of Medicine, Case Western Reserve University, Cleveland, OH; Center for Clinical Informatics Research and Education, MetroHealth, Cleveland, OH.
Clin Lung Cancer. 2023 Jun;24(4):339-346. doi: 10.1016/j.cllc.2023.02.008. Epub 2023 Mar 4.
Rapid outpatient diagnostic programs (RODP) expedite lung cancer evaluation, but their impact on racial disparities in the timeliness of evaluation is less clear.
This was a retrospective analysis of the impact of an internally developed application-supported RODP on racial disparities in timely referral completion rates for patients with potential lung cancer at a safety-net healthcare system. An application screened referrals to pulmonology for indications of lung mass or nodule and presented relevant clinical information that enabled dedicated pulmonologists to efficiently review and triage cases according to urgency. Subsequent care coordination was overseen by a dedicated nurse coordinator. To determine the program's impact, we conducted an interrupted time series analysis of the monthly fraction of referrals completed within 30 days, stratified by those identified as White, non-Hispanic and those that were not (racial and ethnic minorities).
There were 902 patients referred in the 2 years preintervention and 913 in the 2 years postintervention. Overall, the median age was 63 years, and 44.7% of referred patients were female. 44.2% were White, non-Hispanic while racial and ethnic minorities constituted 54.3%. After the intervention, there was a significant improvement in the proportion of referrals completed within 30 days (62.4% vs. 48.2%, P <.01). The interrupted time series revealed a significant immediate improvement in timely completion among racial and ethnic minorities (23%, P < .01) that was not reflected in the majority White, non-Hispanic subgroup (11%, not significant).
A thoughtfully designed and implemented RODP reduced racial disparities in the timely evaluation of potential lung cancer.
快速门诊诊断程序（RODP）加速了肺癌评估，但它们对评估及时性方面的种族差异的影响尚不清楚。
这是一项回顾性分析，旨在研究一个内部开发的应用程序支持的 RODP 对一个医疗保障系统中潜在肺癌患者及时转诊完成率的种族差异的影响。该应用程序筛选了向肺病专家转诊的病例，以确定是否存在肺部肿块或结节，并提供了相关的临床信息，使专门的肺病专家能够根据紧急程度有效地审查和分类病例。随后的护理协调由一名专门的护士协调员负责。为了确定该计划的影响，我们对 30 天内完成的转诊比例进行了中断时间序列分析，按白人、非西班牙裔和非白人（种族和族裔少数群体）进行分层。
在干预前的 2 年中有 902 例患者被转诊，在干预后的 2 年中有 913 例患者被转诊。总体而言，患者的中位年龄为 63 岁，44.7%的被转诊患者为女性。44.2%的患者为白人、非西班牙裔，而种族和族裔少数群体占 54.3%。干预后，30 天内完成的转诊比例显著提高（62.4%比 48.2%，P<0.01）。中断时间序列分析显示，少数族裔的及时完成比例有显著的即刻改善（23%，P<0.01），而在白人、非西班牙裔的大多数患者中并没有反映出来（11%，无显著差异）。
精心设计和实施的 RODP 减少了潜在肺癌评估及时性方面的种族差异。
