title: A multicentre randomised controlled trial of reciprocal lung cancer peer review and supported quality improvement: results from the improving lung cancer outcomes project.
abstract: BACKGROUND
  Results from the National Lung Cancer Audit demonstrate unexplained variation in outcomes. Peer review with supported quality improvement has been shown to reduce variation in other areas of health care but has not been formally tested in cancer multidisciplinary teams. The aim of the current study is to assess the impact of reciprocal peer-to-peer review visits with supported quality improvement and collaborative working on lung cancer process and outcome measures.
  
  
  METHODS
  English lung cancer teams were randomised to usual care or facilitated reciprocal peer review visits followed by 12 months of supported quality improvement. The primary outcome was change in the following national audit indicators; mulitdisciplinary team discussion, histological confirmation, active treatment, surgical resection, small-cell chemotherapy and specialist nurse review. Patient experience was measured using a new lung cancer patient questionnaire in the intervention group.
  
  
  RESULTS
  Thirty teams (31 trusts) entered the intervention group and 29 of these submitted a total of 67 quality improvement plans. Active treatment increased in the intervention group (n=31) by 5.2% compared with 1.2% in the control group (n=48, mean difference 4.1%, 95% CI -0.1 to 8.2%, P=0.055). The remaining audit indicators improved similarly in all groups. Mean patient experience scores in the intervention group did not change significantly during the study but a significant improvement was seen in the scores for the five teams with the worst baseline scores (0.86 to 0.22, P<0.001).
  
  
  CONCLUSIONS
  Reciprocal peer review with supported quality improvement was feasible and effective in stimulating quality improvement activity but resulted in only modest improvements in lung cancer treatment rates and patient experience.
authors.affiliation: Clinical Standards Department, Royal College of Physicians, London NW14LE, UK.
authors.forename: G K
authors.initials: GK
authors.lastname: Russell
authors.affiliation: Clinical Standards Department, Royal College of Physicians, London NW14LE, UK.
authors.forename: S
authors.initials: S
authors.lastname: Jimenez
authors.affiliation: Clinical Standards Department, Royal College of Physicians, London NW14LE, UK.
authors.forename: L
authors.initials: L
authors.lastname: Martin
authors.affiliation: Clinical Audit Support Unit, NHS Information Centre for Health and Social Care, Leeds LS16AE, UK.
authors.forename: R
authors.initials: R
authors.lastname: Stanley
authors.affiliation: 1] Clinical Standards Department, Royal College of Physicians, London NW14LE, UK [2] Department of Respiratory Medicine, Glenfield Hospital, Leicester LE39QP, UK.
authors.forename: M D
authors.initials: MD
authors.lastname: Peake
authors.affiliation: 1] Clinical Standards Department, Royal College of Physicians, London NW14LE, UK [2] Department of Respiratory Medicine, Queen Elizabeth Hospital Birmingham, Birmingham B152WB, UK.
authors.forename: I
authors.initials: I
authors.lastname: Woolhouse
mesh_terms: D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000592:standards*; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D018024:Peer Review, Health Care; D058996:Quality Improvement; D011795:Surveys and Questionnaires