Gaps in Guideline-Concordant Use of Diagnostic Tests Among Lung Cancer Patients.
BACKGROUND
Practice guidelines recommend routine use of pulmonary function tests (PFTs), computed tomography (CT), and positron emission tomography (PET) for the workup of resectable lung cancer patients. Little is known about the frequency of guideline concordance in routine practice.


METHODS
A cohort study (2007 to 2013) of 15,951 lung cancer patients undergoing lobectomy or pneumonectomy was conducted with MarketScan, a claims database of individuals with employer-provided health insurance. Guideline concordance was defined by claims for PFT within 180 days of resection and for CT and PET within 90 days of resection. Generalized linear models were used to evaluate temporal trends, patient characteristics, and costs associated with guideline-concordant care.


RESULTS
Overall, 61% of patients received guideline-concordant care, increasing from 57% in 2007 to 66% in 2013 (p < 0.001). Compared with patients who received guideline-discordant care, patients with guideline-concordant care more frequently underwent repeat testing (PFT: 21% versus 12%, p < 0.001; CT: 46% versus 22%, p < 0.001; PET: 2.3% versus 1.1%, p < 0.001). Health plan-adjusted mean total test-related costs were higher among guideline-concordant patients who underwent repeat testing than patients who did not ($4,304 versus $3,454, p < 0.001).


CONCLUSIONS
Forty percent of lung cancer patients treated with surgical procedures did not receive recommended noninvasive cancer staging and physiologic assessment before resection. Guideline concordance was associated with repeat testing, and repeat testing was associated with higher costs. These findings support the need for quality improvement interventions that can increase guideline concordance while curbing potential excess use of diagnostic tests.
Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center, University of Washington, Seattle, Washington.
Meghan R
MR
Flanagan
Department of Surgery, University of Washington, Seattle, Washington.
Thomas K
TK
Varghese
Department of Surgery, University of Washington, Seattle, Washington.
Leah M
LM
Backhus
Department of Surgery, University of Washington, Seattle, Washington.
Douglas E
DE
Wood
Department of Surgery, University of Washington, Seattle, Washington.
Michael S
MS
Mulligan
Department of Surgery, University of Washington, Seattle, Washington.
Aaron M
AM
Cheng
Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center, University of Washington, Seattle, Washington.
David R
DR
Flum
Department of Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center, University of Washington, Seattle, Washington. Electronic address: ffarjah@uw.edu.
Farhood
F
Farjah
D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000601:surgery; D003952:Diagnostic Imaging / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000592:standards*; D049268:Positron-Emission Tomography / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D012129:Respiratory Function Tests / Q000592:standards*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards