Implementation of a rapid access multidisciplinary pathway to reduce health disparities in veterans with thoracic malignancies.

Abstract

e18583 Background: Lung cancer has higher incidence and lower survival rates in Veterans compared to the general population. Previous investigation at our institution identified delays in care for veterans with new lung cancer diagnoses often due to patient factors including transportation, lodging, or too many appointments. Modifiable factors we aimed to improve included coordination and consolidation of care related to diagnostic work-up. We implemented a rapid access pathway (RAP), including a multidisciplinary panel of providers who review outside referrals for imaging concerning for thoracic malignancy with a goal of identifying appropriate invasive diagnostic work-up prior to initial consultation visit. Patients eligible had an initial telehealth visit and were offered a two-day consolidated diagnostic visit, with lodging. Methods: Retrospective chart review was conducted on veterans referred to the Veterans Affair Ann Arbor Healthcare System for lung cancer work-up and who were eligible for RAP from 10/2021- 12/2022. Data abstracted included veteran demographics, comorbidities, indication for initial imaging, tumor stage, and treatment rendered. Time intervals between abnormal image to multidisciplinary conference (T0), conference to telehealth consult (T1), telehealth consult to tissue diagnosis (T2), tissue diagnosis to treatment (T3), total time from abnormal image to treatment (T4) were calculated. Incidence and type of system delay (SD) versus patient delay (PD) was recorded with each care interval. Results: 306 new consults underwent multidisciplinary review; 20 were eligible for the RAP; 4 declined a consolidated visit. Sixteen Veterans at least partially completed the pathway by the time of analysis. 93% (n = 15) were male, 81% (n = 13) identified as White. Median age at referral was 74 and median Charleston-Comorbidity Index was 5, with 62% having mobility issues. 56% lived at least 50 miles from the Ann Arbor VA. Disease was detected by lung cancer screening in 56%, incidental finding in 37%, and symptom triggered in 6%. Median times to each interval were T0 13.5 days, T1 5.5 days, T2 28 days, T3 34 days and T4 70 days. SD was observed in 11% of patients; most commonly due to administrative scheduling changes. PD occurred in 35% of patients, often prior to diagnostic procedure or treatment initiation; most commonly due to a new hospitalization, patient wanting more time prior to treatment or declining work-up/treatment. Conclusions: Our aim was to expedite diagnosis and treatment of new potential lung cancers in Veterans by mitigating barriers commonly experienced in the healthcare system without compromising quality of care. All veterans who participated in all stages of the RAP received RAND guideline concordant care (time from abnormal image to treatment initiation < 98 days). Ongoing analysis will include clinical outcomes following RAP implementation.