Reducing Racial Disparities in the Timeliness of Potential Lung Cancer Evaluation With a Novel Application-Supported Rapid Outpatient Diagnostic Program: An Interrupted Time Series Analysis

Abstract

Introduction: Rapid outpatient diagnostic programs (RODP) expedite lung cancer evaluation, but their impact on racial disparities in the timeliness of evaluation is less clear.

Materials and 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 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 preintervention and 913 in the 2 years postintervention. 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 <.01). The interrupted time series revealed a significant immediate improvement in timely completion among racial and ethnic minorities (23%, P < .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.

Keywords: Disparities; Lung cancer; Lung nodules; Rapid outpatient diagnostic program; Software.

Figure 1:

Interrupted time series analysis of monthly timely completion rates for patients referred for indications of lung mass or nodule. The shaded box represents the duration of time when the RODP was active.

Figure 2:

Stratified interrupted time series analyses of monthly timely completion rates for patients referred for indications of lung mass or nodule. Strata include white, non-Hispanic, vs. the remaining collective minority subgroup. The shaded box represents the duration of time when the RODP was active.