D-H Lung Cancer Screening- primary care & system perspective

1. D-H Lung Cancer Screening- primary care & system perspective Nancy E. Morden MD MPH May 22, 2014

2. Health Care Complexity “The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves” “Medicine’s complexity has exceeded our individual capabilities as doctors.” Atul Gwande Cowboys & Pit Crews, New Yorker, 2011

3. Well run performance Engines “Great organizations have well run performance engines- . .. . an effective performance engine makes every task, every function, every activity is as repeatable and predictable as possible.” Chris Trimble Jan 2014

4. HMO ACO Population Health PCMH Pioneer CCO MCSSP P4P MCO Shared-Savings Managed Medicaid Shared-Risk Partial Capitation Medicare Full Capitation

5. Evidence-Based Performance Engine • Low Dose Lung Cancer Screening Program • Protocol driven • Active outreach • Systematic eligibility screening • Smoking cessation • Explicit harms v. benefits • Patient decision aid • Embedded clinical tool– MIETGIR • Live CME/CEU event • Enduring on-line education module • Learning program • Tracking & Follow up done at source of test

6. IOM 2020 Challenge • By the year 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence. IOM Roundtable on Evidence-Based Medicine, 2009