Proposed Quality Metrics for Lung Cancer Screening Programs

Lung cancer screening with a low radiation dose chest CT scan is the standard of care for screening-eligible individuals. The net benefit may be optimized by delivering high-quality care, capable maximizing and minimizing harms screening. Valid, feasible, relevant indicators quality lung help programs to evaluate their current practice develop improvement plans. purpose this project was related processes outcomes Potential were explored through surveys multidisciplinary experts. Those that achieved predefined measures consensus each validity, feasibility, relevance domains are proposed as indicators. Each described in detail, guidance on how define, measure, improve program performance within indicator. Screening individuals at high risk developing low-dose (LDCT) scanning reduces mortality.1The National Trial Research TeamReduced lung-cancer mortality computed tomographic screening.N Engl J Med. 2011; 365: 395-409Crossref PubMed Scopus (6292) Google Scholar,2De Koning H.J. van der Aalst C.M. de Jong P.A. et al.Reduced volume randomized trial.N 2020; 382: 503-513Crossref (781) Scholar balance between reduction potential resulting from Most evaluation management screen-detected nodules. Achieving delivery LDCT optimize As guidelines policy shift eligibility criteria include groups lower benefit,3United States Preventive Services Task Force. Cancer. US Force Recommendations. JAMA. 2021;325(10):962-970.Google Scholar,4Meza R, Jeon J, Toumazis I, al. Evaluation benefits tomography modeling study 2021;325(10):988-997.Google provision will become even more important. Quality “the degree which health services populations increase likelihood desired consistent professional knowledge.”5Mainz J. Defining classifying clinical improvement.Int Qual Health Care. 2003; 15: 523-530Crossref (627) Developing an understanding barriers implementing optimal allows us identify means care. can assess track success quality-improvement activities.6Hermens R.P.M.G. Ouwens M.M.T.J. Vonk-Okhuijsen S.Y. al.Development diagnosis treatment patients non-small cell cancer: first step toward multidisciplinary, evidence-based guideline.Lung 2006; 54: 117-124Abstract Full Text PDF (92) measurable elements program’s used care.6Hermens validity measure refers its evidence or consensus-based link improved outcomes. Feasibility indicator measured translated into without undue burden. Relevance indicates room exists improving variability practices likely, would important large portion those whom it applies. To date, formal have not been developed guide programs. Organizations including Forum, Committee Assurance, Better Medicare Alliance provided about process indicators.7Better AllianceImproving Advantage measurement. October 2018. website.https://www.bettermedicarealliance.org/publication/improving-medicare-advantage-quality-measurement/Google Scholar, 8National Commission AssuranceHEDIS 2020 update. 1, 2019.https://www.ncqa.org/wp-content/uploads/2019/09/20190930_HEDIS-2020-Vol-2-Technical-Update.pdfGoogle 9National AssuranceNCQA HEDIS technical resources. Assurance website.https://www.ncqa.org/hedis/measures/Date accessed: November 3, 2020Google includes forming multistakeholder teams, reviewing existing practice, establishing standards, plan data collection analysis, performing pilot testing. Quality-improvement efforts based should shown result Others similar other aspects patient cancer.6Hermens Scholar,10Ouwens Hermens R.R. Termeer R.A.R. al.Quality integrated nonsmall variations determinants care.Cancer. 2007; 110: 1782-1790Crossref (41) Scholar,11Mainz Hansen A.M. Palshof T. Bartels P.D. measurement using indicators: Danish Indicator Project.J Surg Oncol. 2009; 99: 500-504Crossref (55) could programmatic efforts. This Implementation Strategies Group (ISTG) Cancer Roundtable (NLCRT), American Society serves convening body.12National RountableNational Rountable website.https://nlcrt.org/aboutDate 2, For information composition NLCRT, please visit website (https://nlcrt.org/about). ISTG physicians, nonphysician clinicians, nonclinicians (including advocate), all expertise, experience, both leaders list following topics: appropriateness (ie, who screening), shared decision-making, reporting results, screening-detected findings, treatment. members instructions revise language add they believed represented list, but judge developed. revised 30 (e-Appendix 1) then discussed in-person meeting several July 2019, leading prioritization 15 further discussants’ perception importance impact 1). prioritized evaluated survey ISTG. 2) designed questions (one question), feasibility (two questions), (three questions) A 7-point response scale used, ranging 1 = strongly disagree 7 agree. Real-world (means ranges) College Radiology’s (ACR’s) Registry (LCSR) available raters. priori voting thresholds established before survey. An considered if mean ? 5.0, 50% responses 6 (agree agree), 75% 5, 6, (somewhat agree, agree). final question asked respondents provide level consider “high-quality performance.” reached levels expressed percentage ± 25% away (eg, mean, 25%-75%). continuous variable 40 days, 20-60 days). achieving round included second sent 10 NLCRT task groups. same questions, data, used. after defined, provided, considerations optimizing drafted. Of survey, eight had ACR LCSR assist (Table Eleven completed initial 11 responding questions. Seven did not, failed least one relevance, four them also question, three 2).Table 1Topics Initial Drafted Indicators, Prioritized Further Exploration, 8 With Data Available From LCSRTopicDraftedPrioritizedDataWho screened621Shared decision-making422LDCT performance311LDCT findings331Evaluation findings852Diagnosis treatment621Total30158Data presented No. Radiology; Registry; CT. Open table new tab Table 2Survey IndicatorsValidityFeasibilityRelevanceHigh PerformanceLink OutcomeTranslate PracticeMeasurableRoom ImproveVaries Across PracticeLarge Portion Patients1. complete eligible USPSTF 6.6, 100, 91aMet question.6.7, 100aMet question.5.4, 82, 55aMet question.6.5, question.6.4, 91, question.69, N2. examination symptoms concerning 70, 50bDid meet question.5.1, 80, 40bDid question.4.8, 60, question.5.7, 90, 80aMet question.4.2, 50, 30bDid question.38, N3. smokers participate documentation smoking cessation intervention discussion, offer program) during decision-making 90aMet question.6.8, question.5.9, 89, 78aMet question.83, Y4. baseline where has occurred 4.6, question.5.5, question.5.6, 70aMet question.6.1, 60bDid question.73, N5. scans normal BMI exceeds 3 mGy CTDIvol 5.1, 67, 33bDid 56, 56bDid 78, 67aMet 67bDid question.81, N6. LungRADS category 4 finding identified 5.6, question.6.3, 89aMet 88aMet question.5.2, question.5.3, N7. actionable, non-lung nodule 5.5, 60aMet 70bDid question.56, N8. than 5.2, question.4.9, question.49, N9. having 2 findings annual question.6.6, question.78, Y10. surveillance performed mo (± mo) 5.9, question.82, Y11. wk) additional diagnostic 6.3, question.6.2, question.5.8, question.87, Y12. nonsurgical biopsies proven benign question.66, N13. surgical 6.2, question.6, question.61, N14. cancers stage I time 6.5, Y15. days identification 4B 4X mass examination, someone cancer, question.70, NEach statement listed. cells number average score (maximum, 7; threshold, 5.0), 5 (threshold, 75%), third 50%). High except no. 15, represents days. index volume; CT; Reporting System; N achieve performance; Y performance.a Met question.b Did question. performance. seven (139 received email request participate, 80 opened request). Responses 32 36 (22 physician 0 nine nonclinical researchers, five “other”). Six reach somewhat agree threshold “There across spectrum settings” 3).Table 3Survey Indicators That Achieved Consensus Survey 1ValidityFeasibilityRelevanceHigh 5.4, 72, 755.6, 86aMet 64, 81aMet 77, question.6.0, 92aMet 86, question.79, 865.9, 71, 94, 97aMet 976.3, 88, 85, 94aMet question.75, N10. 6.1, 946.3, 85aMet question.84, N11. question.86, 58, 765.8, 73, 79, 82aMet 59bDid 76, question.53, N15. 6.0, 856.3, question.46, Results attempting target suggesting inconsistent. Only (see “First Survey” section) our consistency 2). remaining identified. Five LCSR. In larger requirements, none six 3), nor consensus. Four Through process, we among expertise. Our followed previously methods indicators.1The We structure team experts familiar implementation challenges. when strict standards process. Herein, review discuss approaches collection, improvement. limitations next steps. One screened, guidance, compliance follow-up recommendations, findings. criteria. Definitions: most recently published (specifics because these change guideline updates). Concerning any beginning past months, lasting weeks, present LDCT: cough, shortness breath, pain, hemoptysis, unintentional weight loss > 5% body weight. How calculate: numerator underwent LDC