How Kaiser Permanente Regionalized Lung Surgery

The California-based health system shifted serious lung cancer surgery to five centers of excellence.

A regional approach to lung cancer surgery at Kaiser Permanente improved clinical outcomes and lowered cost of care, recent research shows.

The National Cancer Institute estimates there were 234,000 new lung cancer cases in 2018. Lung cancer has a high mortality rate—the condition accounts for 13.5% of all new cancer cases and 25.3% of all cancer deaths.

The research, which was presented at the 55th Annual Meeting of The Society of Thoracic Surgeons, focused on patients who had major lung cancer surgery such as lobectomy at Kaiser Permanente Northern California hospitals.

The hospitals in the study included five centers of excellence for thoracic surgery that became the sites for the Oakland, California-based health system's regionalization of lung cancer surgery.

The research found that the centers of excellence, which were launched in 2014, were associated with clinical and cost-saving benefits for lung cancer surgery.

• After regionalization, patients spent 1.7 days less in the intensive care unit
   
• Length of stay was reduced 3.3 days
   
• Before regionalization, 13.6 % of patients had major complication and that rate fell to 9.6% after regionalization

Striving for excellence

Researcher Jeffrey Velotta, MD, of Kaiser Permanente Oakland Medical Center and the University of California San Francisco School of Medicine, told HealthLeaders that centers of excellence provide a higher level of care than other hospitals.

"When you have a center of excellence, it leads to standardization. We use protocols such as ERAS—Enhanced Recovery After Surgery programs. If you are at a center of excellence, you are going to get that enhanced recovery program," he said.

Velotta said there were primarily four factors in Kaiser Permanente's selection of sites for the thoracic surgery centers of excellence.

• Distance to patients: "We selected them strategically in terms of distance because we knew distance is always a factor for patients."
   
• Volume: "We wanted to pick the places with the highest number of thoracic surgeon specialists. Facility volume was also important. We picked hospitals where we were already doing a significant amount of lung cancer operations."
   
• Outcomes: "Kaiser Permanente does internal auditing that gives us data analysis of our outcomes. Every month, we know per hospital or region outcomes such as ICU length of stay, regular length of stay, complications, and readmissions. We wanted centers that were getting better outcomes and were doing more surgeries, with a lot of data showing higher volume equals better care and outcomes."
   
• Ancillary staff: "All of the centers already had ancillary staff in place, including cardiothoracic anesthesia, chest radiologists, pulmonologists, and medical and radiation oncologists.

For surgeons, performing procedures at the centers of excellence is an excellent experience, Velotta said.

"We have the same OR staff at the centers of excellence. You have the same circulating nurse and the same scrub tech. It's great have the same circulating nurse who knows where all your instruments are and the same scrub tech who knows exactly how you do things. They know exactly how to set up—it's flawless."