Clinical Variation Reduction in Propensity-matched Patients Treated for Malignant Pleural Effusion

The potential advantages of clinical variation reduction are improved patient outcomes and cost reduction through optimizing and standardizing care. Malignant pleural effusion (MPE) is a common condition encountered by thoracic surgeons that has significant variation in cost and outcomes. The purpose of this investigation was to assess the opportunity of improving patient outcomes and reducing cost by using a standardized treatment algorithm based on evidenced-based care.

Patients treated for MPE using a standardized treatment algorithm at the study institution over a 2 year period were identified and propensity matched to MPE patients from 1 of 6 affiliated hospitals with comprehensive oncology and thoracic surgery services. Matched patients were treated at their physicians' discretion. Factors used in propensity matching were age, performance status, and tumor histology. The 2 cohorts were then compared for interventions, admissions and readmissions, morbidity, and pleural effusion-associated costs. Patients who desired only comfort or hospice care were excluded.

From 2016 through 2018, 60 patients were treated using the standardized algorithm. These patients were propensity matched and the 2 cohorts compared. Patients treated with the algorithm experienced significantly fewer hospital admissions, readmissions, interventions, and costs while having a comparable procedural morbidity.

An evidence-based treatment algorithm for MPE produces superior clinical outcomes to individualized therapy while significantly reducing the costs of care.