title: The effect of a lung cancer care coordination program on timeliness of care.
abstract: BACKGROUND
  Timeliness of care improves patient satisfaction and might improve outcomes. The CCCP was established in November 2007 to improve timeliness of care of NSCLC at the Veterans Affairs Connecticut Healthcare System (VACHS).
  
  
  METHODS
  We performed a retrospective cohort analysis of patients diagnosed with NSCLC at VACHS between 2005 and 2010. We compared timeliness of care and stage at diagnosis before and after the implementation of the CCCP.
  
  
  RESULTS
  Data from 352 patients were analyzed: 163 with initial abnormal imaging between January 1, 2005 and October 31, 2007, and 189 with imaging conducted between November 1, 2007 and December 31, 2010. Variables associated with a longer interval between the initial abnormal image and the initiation of therapy were: (1) earlier stage (mean of 130 days for stages I/II vs. 87 days for stages III/IV; P < .0001); (2) lack of cancer-related symptoms (145 vs. 60 days; P < .0001); (3) presence of more than 1 medical comorbidity (123 vs. 82; P = .0002); and (4) depression (126 vs. 98 days; P = .029). The percent of patients diagnosed at stages I/II increased from 32% to 48% (P = .006) after establishment of the CCCP. In a multivariate model adjusting for stage, histology, reason for imaging, and presence of primary care provider, implementation of the CCCP resulted in a mean reduction of 25 days between first abnormal image and the initiation of treatment (126 to 101 days; P = .015).
  
  
  CONCLUSIONS
  A centralized, multidisciplinary, hospital-based CCCP can improve timeliness of NSCLC care, and help ensure that early stage lung cancers are diagnosed and treated.
authors.affiliation: Frank Netter School of Medicine at Quinnipiac University and Midstate Medical Center, Meriden, CT, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Alsamarai
authors.forename: Xiaopan
authors.initials: X
authors.lastname: Yao
authors.forename: Hilary C
authors.initials: HC
authors.lastname: Cain
authors.forename: Bryan W
authors.initials: BW
authors.lastname: Chang
authors.forename: Herta H
authors.initials: HH
authors.lastname: Chao
authors.forename: Donna M
authors.initials: DM
authors.lastname: Connery
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Deng
authors.forename: Vijay N
authors.initials: VN
authors.lastname: Garla
authors.forename: Laura S
authors.initials: LS
authors.lastname: Hunnibell
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
authors.forename: J Antonio
authors.initials: JA
authors.lastname: Obando
authors.forename: Caroline
authors.initials: C
authors.lastname: Taylor
authors.forename: George
authors.initials: G
authors.lastname: Tellides
authors.forename: Michal G
authors.initials: MG
authors.lastname: Rose
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003299:Cooperative Behavior; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D009367:Neoplasm Staging; D011379:Prognosis; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014728:Veterans
keywords: Cancer navigation; Comorbidities; Non–small-cell lung cancer; Stage migration; Veterans Affairs