Health Services Research & Development

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HSR&D Stories:

Quality Improvement Toolkit Series: Lung Cancer Care

Overview


a clinician examining a lung x-rayA unique partnership among four VA groups, the Lung Cancer Care Toolkit was developed to help individual facilities create a feasible quality improvement plan by recommending specific tools and resources already available to better support clinical decision-making and optimize the delivery of lung cancer care. There are 37 tools available; each one matched to one or more OQP quality indicators to help improve facility performance in specific areas. As of March 2011, the Toolkit website had been accessed by more than 700 users. Lessons learned from this project will guide future quality improvement and implementation efforts towards greater effectiveness.

Additional Resources


The new Quality Improvement Toolkit Series was designed as an interactive website to help VA facilities improve their performance measurement and quality improvement (QI) efforts across a variety of high-priority care conditions (e.g., lung cancer, colorectal cancer, prostate cancer, and palliative care). This online Series is the result of a unique partnership among four VA groups:

  • Office of Quality and Performance (OQP),
  • Office of Systems Redesign and the VA Center for Applied Systems Engineering,
  • VA/HSR&D's Quality Enhancement Research Initiative (QUERI), and
  • HSR&D's Center for Implementation Practice and Research Support (CIPRS).

The first toolkit targets lung cancer. Lung cancer kills more Americans–both men and women–than any other type of cancer 1 . Moreover, studies have shown higher rates of lung cancer incidence and mortality among Veterans.2 The Quality Improvement Toolkit: Lung Cancer Care website was launched in November 2010 to help individual facilities create a quality improvement plan for the care of Veterans with lung cancer by recommending specific tools as linked to specific QI indicators.

About the Toolkit Series

The main goal of the Toolkit Series is to produce and disseminate quality improvement resource Toolkits that will help VA facilities improve performance on OQP quality indicators and performance measures. OQP creates and collects data on evidence-based national benchmarks to measure the quality of preventive and therapeutic VA healthcare services at the facility, VISN, and national levels.

The Toolkit is a collection of tools that target care for a single condition. Tools that become part of a "toolkit" are considered QI innovations–technical, clinical, or organizational–which are currently in use, but have not been systematized throughout VA. Types of tools include:

  • Clinical decision support tools
    • Point-of-care aids, such as Computerized Patient Record System (CPRS) order sets and links to clinical guidelines
  • Patient education and support tools
    • Materials to empower and inform patient and families
  • Organizational and process changes
    • Ideas for better communication and flow of care
  • Patient registries and databases
    • Tools to better manage patients throughout the continuum of care.

Quality Improvement Toolkit: Lung Cancer Care

VA's Office of Quality and Performance conducted a special study on the quality of VA lung cancer care that reported on 25 evidence and/or guideline-based quality indicators and timeliness measures for lung cancer cases, which were newly diagnosed within VA during 2007. Overall the study found good quality of care; however, there was substantial variation across VA facilitates on virtually all measures. This indicated that there was considerable opportunity for improvement, which led to the development of the Quality Improvement Toolkit: Lung Cancer Care.

From its origins as an OQP project, the Toolkit Series was quickly expanded and enhanced by the Toolkit team's connections with HSR&D. With their substantial research experience in VA HSR&D and QUERI, project leads Drs. Jennifer Malin and Steven Asch felt that while producing the Toolkit would be valuable to VA quality managers and clinical leadership, a sustained evaluation effort led by experts in implementation science would greatly enhance the project's value for future Toolkits, as well as similar quality improvement efforts.

The Quality Improvement Toolkit: Lung Cancer Care was initially conceived as a pilot project with an evaluation component to assess uptake and usability; if successful, the Toolkit production pipeline could be recommended as a cost-effective means of sharing locally-developed innovations across VA. Therefore, the Toolkit team has been working in partnership with the national QUERI office and CIPRS, both guiding the progress of the project and shaping the multi-part evaluation plan. David Atkins, M.D., M.P.H., QUERI Director, and Brian Mittman, Ph.D., CIPRS Director, have been central in the creation and development of the Toolkit Series as members of the Toolkit Advisory Board.

The Lung Cancer Care Toolkit provides a feasible quality improvement plan by recommending specific tools and resources already available to better support clinical decision-making and optimize delivery of lung cancer care. Every tool has been matched to one or more OQP quality indicators to help quickly target ways to improve facility performance in specific areas. There are 37 available tools that include:

  • CPRS link to practice guidelines,
  • Thoracic surgery consult,
  • Multi-disciplinary tumor board,
  • vVirtual tumor board,
  • Lung nodule tracking database,
  • Lung nodule clinic,
  • Cancer care coordinator,
  • Patient education material for diagnosis and work-up, and
  • Caregiver support resources.

Impact

Projects are being developed to help assess the success and impact of the Quality Improvement Toolkit: Lung Cancer Care in three ways:
  • Short-term impact: Intended users—clinicians, quality managers, and clinical leaders—access the website, where they find, download, install, and use innovations they consider potentially helpful in their specific clinical setting. As of March 2011, the Toolkit website has been accessed by more than 700 unique users, and many tools have been downloaded, suggesting early success on this first measure.
  • Intermediate-term impact: Information of which facilities implemented specific tools results can be linked to changes in facility performance as measured by OQP quality indicators or other VA quality metrics. This will help determine whether the tools helped a facility improve adherence to guidelines of care in priority areas.
  • Long-term impact: Lessons learned from this project about how to create and disseminate a cost-effective toolkit will be shared nationally, and will guide future quality improvement and implementation efforts towards greater effectiveness.

Where to Access Toolkits

At this time, the Toolkit website may be accessed from a VA network computer only. The Lung Cancer Care Toolkit, along with the second in the series addressing colorectal cancer care, are now available online via the VA Intranet at https://vaww.visn11.portal.va.gov/sites/Indianapolis/verc/occ/Pages/help.aspx.

Toolkit Development Team

The Toolkit Series Development Team is based at the VA Greater Los Angeles Healthcare System and the VA Center for Applied Engineering in Indianapolis. Steven Asch, M.D., M.P.H., and Jennifer Malin, M.D., Ph.D., lead the project with the advice of an Advisory Board comprised of HSR&D, VA Central Office, and Operation leaders. Dr. Asch is Director of the HIV/Hepatitis C QUERI Center, with longstanding experience in quality improvement projects. Dr. Malin has substantial expertise in oncology, as well as a broad background in quality of care research. The evaluation effort is led by Jeff Luck, Ph.D., an expert in healthcare evaluation who also is affiliated with CIPRS. The Development Team works in partnership with QUERI leadership and CIPRS to guide the evaluation effort and to cross-promote and support projects with stakeholders from both health services research and VA Operations. For more information about the Quality Improvement Toolkit Series, please contact project manager, Laura York, M.A. at Laura.York@va.gov.

References

  1. Lung Cancer Statistics. Centers for Disease Control and Prevention.
  2. Lung Cancer as it Affects Veterans and Military. Lung Cancer Alliance.