P154 The improving lung cancer outcomes project: a study of the feasibility of a national reciprocal peer review and facilitated quality improvement programme

Abstract

Background: Variation exists in lung cancer outcomes in the UK,which does not appear to be wholly explained by differences in casemix. The Improving Lung Cancer Outcomes Project aims to addressthis via a 2 year programme of national reciprocal peer review andfacilitated quality improvement. We describe the feasibility andacceptability of delivering this programme over the first year. Methods: All NHS trusts in England were invited to take part. Thosewho agreed were paired on the basis of contrasting results in fourheadline indicators from the national lung cancer audit. 15 pairswere randomised to the intervention arm and the remaining pairsacted as controls. The intervention group were invited to participatein workshops, reciprocal site visits, patient experience surveys andfacilitated quality improvement (QI) work. Evaluation of thisactivity was performed using anonymous feedback, interviews withparticipants and observations of programme activities by externalresearchers. Results: 92 of 156 (59%) trusts agreed to participate. The site visitsfor the 15 pairs in the intervention arm took 6 months to completeand were attended by a total of 210 MDT members. The visits wereseen as supportive yet opened up the possibility of legitimatechallenge to existing ways of working. All 30 trusts in the interventiongroup were represented in the first patient survey, whichhad an overall response rate of 49%. However returns for individualtrusts were low which reduced perceived credibility in some cases.71 QI plans were submitted by 29 of the 30 trusts. These focused ona range of areas including data collection, diagnostics, and access toclinical nurse specialists. Considerable revision of the QI plans wasrequired to ensure alignment with the overall project aims. Conclusions: We have demonstrated that reciprocal peer review andfacilitated quality improvement planning is both feasible andacceptable as part of a national lung cancer improvement project.Organising timely site visits, providing credible patient feedback andmaintaining the focus of quality improvement plans is challengingand requires considerable resource. The overall effect of theprogramme on patient experience and outcomes is awaited withinterest.