Impacts of a clinical quality registry on lung cancer quality measures: A retrospective observational study of the Victorian Lung Cancer Registry.

Abstract

Aim Clinical quality registries (CQRs) monitor the quality of healthcare by collecting, analysing and reporting benchmarked clinical quality performance outcomes to stakeholder institutions, with the objective of closing the research evidence-practice gap. Little is known of the effects of CQR function on clinical outcomes in lung cancer. Materials and methods We studied the attainment of 25 clinical quality indicators (CQIs), in consecutive, newly diagnosed lung cancer patients to assess longitudinal unwarranted clinical variation, quality indicator attainment and consequent survival impacts. This study was an observational cohort study of the Victorian Lung Cancer Registry in Victoria, Australia, between 2016 and 2021. Results We studied 12,121 consecutive patients, observing substantial variation in care in institutional indicator attainment for all indicators ranging from very low (2.1%) to high (90%) at study outset. Indicator attainment over time increased (n = 6 indicators), remained stable (n = 17), and decreased (n = 2). The attainment of CQI was associated with a significant reduction in mortality hazard for the majority of indicators (n = 15; HR reduced 10%–67%), and an increase in mortality hazard associated with 3 indicators (HR increased 32%–48%). Population level evaluation of indicators revealed multiple modifiable drivers that may be targeted to enhance indicator attainment. Non-small cell lung cancer (NSCLC) survival analysis identified significant improvement evident for stage II and IV NSCLC in the pre-COVID era and stage I overall. Conclusion Clinical quality registries are potentially transformative tools for the definition and engagement of learning health systems in the healthcare quality improvement cycle. This study identified significant variation in hospital lung cancer CQI attainment and unwarranted variation between stakeholder sites. Stakeholder focus on this variation provides context-specific opportunity to identify local improvement opportunities. These process measures impact outcome measures, including survival, and enable the evaluation of the evidence-practice gap for service innovation and iterative quality improvement.