Original article
General thoracic
The Effects of a Multidisciplinary Care Conference on the Quality and Cost of Care for Lung Cancer Patients

Presented at the Fifty-first Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 26–28.
https://doi.org/10.1016/j.athoracsur.2015.05.056Get rights and content

Background

A prospective, multidisciplinary care conference (MDC) has been shown to result in measurable benefits for patients with non-small cell lung cancer (NSCLC). However whether a MDC also results in a difference in resource utilization and cost as well as whether these benefits persist across a multiinstitutional system has not been reported. This investigation compared propensity-matched patients with NSCLC whose care was coordinated through a MDC to patients without access to an MDC across a geographically diverse system of hospitals.

Methods

The Premiere database (Premier Inc, Charlotte, NC) for a health system’s 70 hospitals was used to identify patients undergoing treatment for NSCLC during a 5-year period. Propensity matching was used to populate an MDC and non-MDC cohort. The two cohorts were compared for the costs of staging and diagnosis as well as the timeliness and quality of care metrics.

Results

Between 2008 and 2013, 13,254 patients were propensity matched. Patient demographics and Charlson comorbidity scores were comparable after matching. Significant differences were identified in adherence to national guidelines (p < 0.0001) for staging and treatment (p < 0.0001), timeliness of care (p < 0.0001), and costs (p < 0.0001) between the two groups.

Conclusions

This investigation found that patients with NSCLC realize improved quality and timeliness of care when that care is coordinated through an MDC. The use of an MDC was also associated with a significant reduction in cost. These differences persisted across a geographically diverse set of hospitals, providers, and patients. Prospective MDCs should be considered integral and compulsory for patients with NSCLC.

Section snippets

Patients and Methods

This study was designed as a retrospective cohort analysis. The St. Vincent Hospital Institutional Review Board approved the study, and individual patient consent was not required with the condition of patient anonymity outside the initial data-gathering phase of the study. The Premier inpatient database (Premier Inc, Charlotte, NC) was used to identify patients diagnosed with NSCLC (International Classification of Diseases, Ninth Revision [ICD-9] diagnosis codes 162.2, 162.3, 162.4, 162.5,

Results

During the 6-year study period, 15,731 patients with NSCLC were identified at 49 hospitals in 26 states that met the entrance criteria for this investigation. After a determination of whether identified treatment facilities did or did not have an MDC that met this investigation’s criteria, 6,627 patients met the patient and facility inclusion criteria for the MDC cohort from 27 hospitals. These MDC patients were propensity matched, as previously described, to 6,627 patients who met the patient

Comment

Several investigations have outlined the benefits of a prospective, MDC for the evaluation and treatment planning of patients with malignancy. In a 2009 report, our group found that an MDC significantly increased the percentage of patients receiving complete staging, a multidisciplinary evaluation, and adherence to nationally accepted care guidelines while decreasing the interval from diagnosis to treatment in patients with NSCLC cancer [10]. We reported similar findings for patients with

References (16)

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