Dr. Raymond Osarogiagbon, MBBS, FACP is LUNGevity Foundation’s third Community Champions recipient.
During his tenure at Baptist Memorial Health Care, Dr. Osarogiagbon has overseen the successful growth of Baptist’s lung cancer initiatives, targeting communities across Arkansas, Mississippi and Tennessee. These efforts include a tobacco control program, low-dose CT lung cancer screenings, with the ultimate goal of reducing lung cancer mortality in the Mid-South.
Dr. Osarogiagbon and his team are working hard to change outcomes for communities in Memphis Metropolitan Area, where the challenge of healthcare disparities are particularly severe. While aggregate U.S. statistics show a steady decline in lung cancer incidence and mortality, the Mid-Southern area continues to see stable or rising lung cancer incidence and mortality.
LUNGevity was recently able to sit down with Dr. Osarogiagbon to discuss his work in Memphis and his hope for those affected by lung cancer in the future.
Please tell us about your role and function within your organization. What led you to your current career path?
I am a Thoracic Medical Oncologist actively engaged in the clinical care of lung cancer. I am a Health Services Researcher who utilizes population science, implementation science, and team science approaches to tackle the wicked challenge of overcoming barriers to uniformly high-quality cancer care for diverse populations. As a Healthcare Administrator, I am also involved in building high-performing clinical care delivery programs.
I started testing my ideas about program-based approaches to cancer care delivery as Chief of Medicine at the Amarillo, Texas, VA Medical Center from 2002 to 2005 and purposefully relocated to the Memphis Metropolitan area to embed myself in a region of the U.S. where the challenge of healthcare disparities seemed particularly severe.
Can you share a description of the high-risk lung cancer communities that you engage and empower?
My healthcare system has major infrastructures in Mississippi, Arkansas, and Tennessee, with a service area population across 107 counties that also includes Southwest Kentucky, Southeast Missouri (‘The Missouri boot-heel’), and Northwest Alabama.
Our service area states have some of the highest per capita cancer (including lung cancer) incidence and mortality rates in the U.S. Our service area counties are demographically diverse. Historically our lung cancer patient population has been around 70% Caucasian and 30% Black or African-American. Our service area counties are also socioeconomically diverse: 44% of our 107 counties are persistent poverty counties located in the Delta Regional Authority’s catchment area. The Delta Regional Authority covers a region congressionally identified as having some of the greatest socioeconomic and health challenges in the U.S. population. Similar to the Appalachian Regional Commission, many of our service area county populations continue to see stable or rising lung cancer incidence and mortality statistics, contrary to the aggregate U.S. statistics that show a steady decline in lung cancer incidence and mortality.
What do you want others in the health care ecosystem to know about disparities in lung cancer care within the communities that you serve?
Emblematic of the global experience, the delivery of lung cancer care has traditionally been fragmented and chaotic in the Mid-Southern USA, whereas the complexity of thoracic oncology care mandates robust structural and process organization to achieve better outcomes. We have found our population to be a rich learning laboratory for close examination of the causes and consequences of disparate care delivery. More importantly, it provides an excellent environment for experimenting with rationally designed solutions.
Many of the discoveries we have made relating to the subject have proven to be generalizable to the global lung cancer care community. Examples include our work highlighting the lung surgical quality gap and the possibility of its elimination and implementing, testing, and proving the value of interdisciplinary delivery models. There is also the ‘Detecting Early Lung Cancer (DELUGE) in the Mississippi Delta’ project, in which we are implementing early lung cancer detection programs that combine low-dose CT screening with algorithmic management of incidentally detected lung nodules.
What are some of the unique barriers or opportunities that you face in your work?
The combination of patient-level cultural, class, and demographic diversity, combined with geographic rurality (large segments of our populations reside in rural areas with the additional challenges this represents) create real barriers to optimal care delivery. However, overcoming the problem of healthcare disparities requires engagement at the social policy, organizational and provider levels, not just at the level of individual vulnerable populations.
Our greatest obstructions are organizational and provider-level barriers. Targeting these provides us with the possibility to serve our populations more effectively. However, the solution to these issues must be policy-driven: creating the necessary incentives for organizations and providers to serve our diverse population. For example, despite the high volume of patients, healthcare financing in the U.S. especially punishes the poor and other vulnerable populations. Recruiting professionals with the skillsets needed for high-quality care delivery is particularly challenging in our region; most of our care providers are private practice clinicians. Adopting common population-level goals for quality benchmarking and improvement can be challenging for clinicians and organizations that traditionally had narrowly defined incentives for care delivery.
What programs or efforts has your organization put in place to address needs to support the communities that you serve?
At Baptist Cancer Center, we are executing an operationally funded 10-year initiative to reduce population-level lung cancer mortality in our service area.
In this project, we seek to disseminate seven specific programs across the healthcare system: tobacco control, low-dose CT lung cancer screening, algorithmic management of incidentally-detected lung nodules, multidisciplinary decision-making, surgical quality improvement by routine use of a lymph node specimen collection kit, pathology quality improvement with a novel gross dissection method, and clinical research infrastructure. Five of these seven projects were previously funded by extramural grants from the NIH or PCORI, the exceptions being our tobacco control and low-dose screening CT program development efforts. This highly rigorous approach to program development has provided us with the deep knowledge with which to execute this initiative.
What gives you hope about the future of lung cancer care?
Challenge is only an opportunity in disguise. We have entered a golden age in thoracic oncology, running the spectrum from early detection, biomarker-directed personalized care to more effective treatment for the full spectrum of the population of patients. I believe that lung cancer will become a chronic, if not routinely curable, disease, such as tuberculosis, within my professional lifetime. Achieving this will mandate that we radically simplify and broaden our research infrastructure, and actively disseminate high-quality programs, to reach the full diversity of the population who stand to benefit from our exciting discoveries.
Related Reading:
- Raymond U. Osarogiagbon, MBBS, FACP, Named LUNGevity Foundation’s Community Champion Honoree
- LUNGevity's Health Equity Council
- Life As a Long-Term Cancer Survivor
The job of bridging gaps caused by healthcare disparities falls to community leaders who, through advocacy, education initiatives, and targeted medical intervention, work to meet the needs of the most vulnerable populations. LUNGevity’s Community Champions program identifies and shines a light on community leaders whose work in engaging vulnerable communities with lung cancer programs can inspire others.