Enhancing lung cancer surgical quality: Insights from a national quality improvement collaborative.

Abstract

11140 Background: Sampling of at least 3 mediastinal and at least 1 hilar lymph node stations during lung cancer resection was adopted by the American College of Surgeons (ACS) Commission on Cancer (CoC) as Operative Standard 5.8 to ensure appropriate staging, guide adjuvant systemic therapy, and improve overall survival. Early assessments suggested difficulty with reaching goal hospital-level compliance rates of ≥80%. The objectives of this study were to compare compliance with Standard 5.8 before and after participation in the Lung NODES national quality improvement (QI) collaborative and to identify facilitators to achieving compliance. Methods: Lung NODES enrolled 354 CoC-accredited hospitals in January 2024. Over 12 months, all hospitals actively participated in guided root cause analyses, educational webinars, peer-to-peer learning, and the development and implementation of hospital-level strategies. Baseline and post-participation surveys collected data on Standard 5.8 compliance and differences in hospital-level compliance were assessed using Wilcoxon signed-rank tests. The post-participation survey queried hospitals on facilitators to achieving compliance. Results: The number of hospitals achieving ≥80% compliance with Standard 5.8 increased from 144 (40.7%) to 238 (67.2%) from baseline to post-participation, respectively. Hospital-level median compliance increased from 67.8% (IQR 42.9-90) to 90.5% (IQR 70-100), p<0.001. All hospital types had an increase in mean absolute difference in compliance, with the largest increase seen for community hospitals (25.4%, STD 43.5) (Table). For the 114 programs that newly achieved compliance, facilitators included surgeon buy-in (83.3%), proactive specimen labeling (76.3%), and multidisciplinary communication (73.7%). Conclusions: Participation in Lung NODES was associated with higher compliance with Standard 5.8 irrespective of hospital type, suggesting that national QI collaboratives may represent an effective large-scale approach to address gaps in cancer care delivery. Operative standard 5.8 compliance by hospital type at baseline and after participation in Lung NODES. Hospital Type Baseline Compliant Programsn (%) Final Compliant Programsn (%) Baseline Compliance Median (IQR) Final Compliance Median (IQR) Absolute Difference in ComplianceMean (STD) Academic N= 50 19 (38.0) 38 (76.0) 68.7 (35.0-90.0) 88.9 (80.0-100) 20.0 (29.8) Community N=32 10 (31.3) 21 (65.6) 56.3 (23.6-83.8) 93.4 (66.7-100) 25.4 (43.5) Comprehensive Community N=147 55 (37.4) 97 (66.0) 65.0 (42.9-89.5) 91.7 (66.7-100) 17.5 (30.3) Integrated Network N=102 51 (50.0) 68 (66.7) 78.6 (50.0-92.2) 90.2 (70.6-100) 12.8 (29.0) Other N=23 9 (39.1) 14 (60.9) 69.0 (40.0-81.7) 84.6 (60.0-100) 13.2 (35.1)