Abstract
Objective
Rapid outpatient diagnostic programs (RODP) expedite lung cancer evaluation, but their
impact on racial disparities in the timeliness of evaluation is less clear.
Methods
This was a retrospective analysis of the impact of an internally developed application-supported
RODP on racial disparities in timely referral completion rates for patients with potential
lung cancer at a safety-net healthcare system. An application screened referrals to
pulmonology for indications of lung mass or nodule and presented relevant clinical
information that enabled dedicated pulmonologists to efficiently review and triage
cases according to urgency. Subsequent care coordination was overseen by a dedicated
nurse coordinator. To determine the program's impact, we conducted an interrupted
time series (ITS) analysis of the monthly fraction of referrals completed within 30
days, stratified by those identified as white, non-Hispanic and those that were not
(racial and ethnic minorities).
Results
There were 902 patients referred in the 2 years pre-intervention and 913 in the 2
years post-intervention. Overall, the median age was 63 years, and 44.7% of referred
patients were female. 44.2% were white, non-Hispanic while racial and ethnic minorities
constituted 54.3%. After the intervention, there was a significant improvement in
the proportion of referrals completed within 30 days (62.4% vs. 48.2%, p<0.01). The
ITS revealed a significant immediate improvement in timely completion among racial
and ethnic minorities (23%, p<0.01) that was not reflected in the majority white,
non-Hispanic subgroup (11%, not significant).
Conclusion
A thoughtfully designed and implemented RODP reduced racial disparities in the timely
evaluation of potential lung cancer.
Micro abstract
Rapid outpatient diagnostic programs (RODP) expedite lung cancer evaluation, but their
impact on racial disparities in the timeliness of evaluation is less clear. Through
a robust interrupted time series analysis, we demonstrated how a unique application-supported
RODP reduced racial disparities in timely referral completion rates for patients referred
to pulmonology with potential lung cancer at a safety-net healthcare system.
Keywords
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Article info
Publication history
Accepted:
February 27,
2023
Received in revised form:
February 25,
2023
Received:
October 16,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: YT reports partial support from UL1 TR002548 from NCATS/NIH
Author's contributions: All authors were involved in the design and implementation of the study and contributed to the generation, refinement, and approval of the final manuscript.
Conflict of Interest Statement – Dr. Tarabichi provides paid consulting to Beckman Coulter for their unrelated work on electronic health record driven sepsis early warning systems. The remaining authors report no conflicts of interest.
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