Copeland Jessica, Neal Eliza, Phillips Will, Hofferberth Sophie, Lathan Christopher, Donington Jessica, Colson Yolonda
Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
MethodsX. 2023 Aug 24;11:102338. doi: 10.1016/j.mex.2023.102338. eCollection 2023 Dec.
The diagnosis and treatment of lung cancer is challenged by complex diagnostic pathways and fragmented care that can lead to disparities for vulnerable patients. Our model involved a multi-institutional, multidisciplinary conference to address the complexity of lung cancer care in vulnerable patient populations. The conference was conducted using a process adapted from the problem-solving method entitled FastTrack, pioneered by General Electric. Conference attendees established critical social determinants of health specific to lung cancer and designed a practical care model to accelerate diagnosis and treatment in this population. The resulting care delivery model, the Lung Cancer Strategist Program (LCSP), was led by a lung cancer trained advanced practice provider (APP) to expedite diagnosis, surgical and oncologic consultation, and treatment of a suspicious lung nodule. We compared the timeliness of care, care efficiency, and oncologic outcomes in 100 LCSP patients and 100 routine referral patients at the same thoracic surgery clinic. Patient triage through our integrated care model transitioned initial referral evaluation to a lung cancer trained APP to coordinate multidisciplinary patient-centered care that was highly individualized and significantly reduced the time to diagnosis and treatment among vulnerable patients at high-risk for treatment delay due to healthcare disparities.•To develop the Lung Cancer Strategist Program care model, we used a three-step (), team-based, problem-solving process entitled FastTrack.•An advantage of FastTrack is its ability to overcome barriers embedded within hierarchal and institutional social systems, empowering those closest to the relevant issue to propose and enact meaningful change.•Under this framework, we engaged a diverse field of experts to assess systemic barriers in lung cancer care and design an innovative care pathway to improve the timeliness and efficiency of lung cancer care in patients at risk for healthcare disparities.
肺癌的诊断和治疗面临着复杂的诊断路径和分散的护理挑战,这可能导致弱势患者出现差异。我们的模式涉及一个多机构、多学科会议,以应对弱势患者群体中肺癌护理的复杂性。该会议采用了一种改编自通用电气首创的名为FastTrack的解决问题方法的流程。会议参与者确定了肺癌特有的关键健康社会决定因素,并设计了一个实用的护理模式,以加速该人群的诊断和治疗。由此产生的护理提供模式,即肺癌策略师计划(LCSP),由一名接受过肺癌培训的高级实践提供者(APP)领导,以加快对可疑肺结节的诊断、手术和肿瘤学咨询及治疗。我们比较了同一胸外科诊所的100名LCSP患者和100名常规转诊患者的护理及时性、护理效率和肿瘤学结果。通过我们的综合护理模式进行患者分流,将初始转诊评估转交给一名接受过肺癌培训的APP,以协调以患者为中心的多学科护理,这种护理高度个性化,并显著缩短了因医疗差距而面临治疗延迟高风险的弱势患者的诊断和治疗时间。•为了开发肺癌策略师计划护理模式,我们使用了一个名为FastTrack的三步、基于团队的解决问题流程。•FastTrack的一个优势是它能够克服等级制度和机构社会系统中固有的障碍,使最接近相关问题的人能够提出并实施有意义的变革。•在这个框架下,我们邀请了不同领域的专家评估肺癌护理中的系统性障碍,并设计了一条创新的护理途径,以提高面临医疗差距风险的患者肺癌护理的及时性和效率。