Michelle Ju1, Sam C Wang1, Samira Syed2, Deepak Agrawal3, Matthew R Porembka4. 1. Division of Surgical Oncology, Department of Surgery, Parkland Health and Hospital System, University of Texas Southwestern Medical Center, Dallas, TX, USA. 2. Division of Hematology/Oncology, Department of Internal Medicine, Parkland Health and Hospital System, University of Texas Southwestern Medical Center, Dallas, TX, USA. 3. Division of Digestive and Liver Disease, Department of Internal Medicine, Parkland Health and Hospital System, University of Texas Southwestern Medical Center, Dallas, TX, USA. 4. Division of Surgical Oncology, Department of Surgery, Parkland Health and Hospital System, University of Texas Southwestern Medical Center, Dallas, TX, USA. matthew.porembka@utsouthwestern.edu.
Abstract
BACKGROUND: Gastric cancer treatment initiation is a complex process. Inefficiencies in care coordination can lead to significant delays, which are often more prominent at safety net hospitals. Multidisciplinary teams (MDTs) have been proposed as an effective solution. METHODS: A retrospective review of sequential gastric cancer patients receiving treatment at Parkland Hospital (Dallas, TX) between 2013 and 2015 was performed before (n = 50) and after (n = 50) creation of a MDT and standardized care pathways. Patients undergoing urgent resection were excluded. Time to treatment (TTT) from initial endoscopy to initiation of chemotherapy was evaluated. The number of diagnostic tests performed and treatment variability also were compared. RESULTS: Groups were similar in terms of age, sex, stage distribution, tumor location, and type of presentation (outpatient vs. emergency room). Post-intervention, TTT decreased from 84.1 ± 12.3 to 32.5 ± 15.2 days (p < 0.02). This decrease was primarily related to parallel performance of subspecialty evaluations, staging studies, and procedures. MDT review reduced the number of unnecessary staging tests performed, leading to a decrease in the average number of studies from 3.8 per patient to 2.2 (p < 0.05). Use of diagnostic laparoscopy in patients with clinically locally advanced disease increased from 18 to 94% (p < 0.05). CONCLUSIONS: Creation of a gastric cancer MDT and uniform care pathways at a large safety net hospital expedited initiation of treatment, reduced unnecessary tests, and promoted consistent patient management.
BACKGROUND:Gastric cancer treatment initiation is a complex process. Inefficiencies in care coordination can lead to significant delays, which are often more prominent at safety net hospitals. Multidisciplinary teams (MDTs) have been proposed as an effective solution. METHODS: A retrospective review of sequential gastric cancerpatients receiving treatment at Parkland Hospital (Dallas, TX) between 2013 and 2015 was performed before (n = 50) and after (n = 50) creation of a MDT and standardized care pathways. Patients undergoing urgent resection were excluded. Time to treatment (TTT) from initial endoscopy to initiation of chemotherapy was evaluated. The number of diagnostic tests performed and treatment variability also were compared. RESULTS: Groups were similar in terms of age, sex, stage distribution, tumor location, and type of presentation (outpatient vs. emergency room). Post-intervention, TTT decreased from 84.1 ± 12.3 to 32.5 ± 15.2 days (p < 0.02). This decrease was primarily related to parallel performance of subspecialty evaluations, staging studies, and procedures. MDT review reduced the number of unnecessary staging tests performed, leading to a decrease in the average number of studies from 3.8 per patient to 2.2 (p < 0.05). Use of diagnostic laparoscopy in patients with clinically locally advanced disease increased from 18 to 94% (p < 0.05). CONCLUSIONS: Creation of a gastric cancer MDT and uniform care pathways at a large safety net hospital expedited initiation of treatment, reduced unnecessary tests, and promoted consistent patient management.
Authors: Michelle R Ju; John D Karalis; James-Michael Blackwell; John C Mansour; Patricio M Polanco; Mathew Augustine; Adam C Yopp; Herbert J Zeh; Sam C Wang; Matthew R Porembka Journal: Ann Surg Oncol Date: 2021-01-02 Impact factor: 5.344
Authors: Hujie Wang; Martina Buljac-Samardzic; Wenxing Wang; Jeroen van Wijngaarden; Shasha Yuan; Joris van de Klundert Journal: Front Public Health Date: 2021-12-17