Multidisciplinary virtual management of pulmonary nodules

Area of Science:

• Pulmonology
• Oncology
• Health Services Research

Background:

• Multidisciplinary nodule clinics enhance care quality and guideline adherence.
• Virtual care models offer potential cost savings and improve patient satisfaction.
• The establishment of a virtual lung nodule clinic (VLNC) addresses the need for efficient and guideline-adherent lung nodule management.

Purpose of the Study:

• To describe the operational first year of a multidisciplinary virtual lung nodule clinic.
• To characterize the patient population evaluated and the decisions made by the VLNC.
• To assess the guideline adherence of previous follow-up management for patients discharged from the VLNC.

Main Methods:

• An observational study of all patients evaluated by the VLNC between March 2018 and March 2019.
• Collection of clinical and radiological data for all patients.
• Classification of recommendations (follow-up, discharge, referral) based on 2017 Fleischner Society guidelines and assessment of prior management adherence in discharged patients.

Main Results:

• 365 patients were evaluated, with a median age of 64 years; 64% had a smoking history and 23% had COPD.
• 43.8% of patients were discharged after the initial VLNC evaluation.
• Among discharged patients, 66.9% had received inadequate follow-up management, with a notable tendency towards overmanagement.

Conclusions:

• The VLNC successfully managed a patient cohort at high risk for lung cancer, emphasizing guideline adherence.
• Approximately half of the patients evaluated by the VLNC were discharged, indicating appropriate case selection and management.
• Pre-VLNC follow-up management for discharged patients was frequently non-adherent to guidelines, highlighting a need for improved care pathways.