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Adherence to Lung Cancer Screening in a Veterans Population Using Centralized and Decentralized Approaches
BACKGROUND
Implementation of lung cancer screening (LCS) in high-risk individuals reduces the risk of dying from lung cancer. The mortality benefit of LCS, however, can only be fully actualized in patients who adhere to follow-up screening examinations. Question: Does a centralized program offer better adherence to lung cancer screening compared with a decentralized approach?
METHODS
A retrospective analysis of a large Veterans Affairs medical center LCS program was conducted to compare adherence to follow-up screening in veterans established through the consult-based (centralized) program with those screened by primary care providers (decentralized). In addition, imaging referral rates from the centralized program were longitudinally reviewed and compared. The cohort included patients completing an LCS imaging examination between 10/2020 and 1/2022. Annual adherence was assessed in patients with a baseline Lung CT Screening Reporting and Data System (Lung-RADS) score of 1 or 2 and was defined as returning for follow-up imaging within 15 months. Outcomes among patients undergoing screening using a centralized and decentralized approach were compared using a two-proportion z-test.
RESULTS
A total of 1,114 patients with a baseline Lung-RADS score of 1 or 2 were included. The amount of low-dose CT (LDCT) imaging ordered for LCS increased exponentially from 2021 to 2023; however, a higher percentage of LDCT examinations were ordered via the decentralized approach, with no significant change observed over time (76%, 71%, and 74% in 2021, 2022, and 2023, respectively). Overall adherence was 42%. Within the centralized program, adherence was 74% compared to 34% using a decentralized approach (p <0.001).
IMPLICATIONS
Adherence to annual screening among eligible veterans is greater within a centralized program. Future research aimed at identifying barriers and maximizing adherence to LCS is needed.
BACKGROUND
Implementation of lung cancer screening (LCS) in high-risk individuals reduces the risk of dying from lung cancer. The mortality benefit of LCS, however, can only be fully actualized in patients who adhere to follow-up screening examinations. Question: Does a centralized program offer better adherence to lung cancer screening compared with a decentralized approach?
METHODS
A retrospective analysis of a large Veterans Affairs medical center LCS program was conducted to compare adherence to follow-up screening in veterans established through the consult-based (centralized) program with those screened by primary care providers (decentralized). In addition, imaging referral rates from the centralized program were longitudinally reviewed and compared. The cohort included patients completing an LCS imaging examination between 10/2020 and 1/2022. Annual adherence was assessed in patients with a baseline Lung CT Screening Reporting and Data System (Lung-RADS) score of 1 or 2 and was defined as returning for follow-up imaging within 15 months. Outcomes among patients undergoing screening using a centralized and decentralized approach were compared using a two-proportion z-test.
RESULTS
A total of 1,114 patients with a baseline Lung-RADS score of 1 or 2 were included. The amount of low-dose CT (LDCT) imaging ordered for LCS increased exponentially from 2021 to 2023; however, a higher percentage of LDCT examinations were ordered via the decentralized approach, with no significant change observed over time (76%, 71%, and 74% in 2021, 2022, and 2023, respectively). Overall adherence was 42%. Within the centralized program, adherence was 74% compared to 34% using a decentralized approach (p <0.001).
IMPLICATIONS
Adherence to annual screening among eligible veterans is greater within a centralized program. Future research aimed at identifying barriers and maximizing adherence to LCS is needed.
BACKGROUND
Implementation of lung cancer screening (LCS) in high-risk individuals reduces the risk of dying from lung cancer. The mortality benefit of LCS, however, can only be fully actualized in patients who adhere to follow-up screening examinations. Question: Does a centralized program offer better adherence to lung cancer screening compared with a decentralized approach?
METHODS
A retrospective analysis of a large Veterans Affairs medical center LCS program was conducted to compare adherence to follow-up screening in veterans established through the consult-based (centralized) program with those screened by primary care providers (decentralized). In addition, imaging referral rates from the centralized program were longitudinally reviewed and compared. The cohort included patients completing an LCS imaging examination between 10/2020 and 1/2022. Annual adherence was assessed in patients with a baseline Lung CT Screening Reporting and Data System (Lung-RADS) score of 1 or 2 and was defined as returning for follow-up imaging within 15 months. Outcomes among patients undergoing screening using a centralized and decentralized approach were compared using a two-proportion z-test.
RESULTS
A total of 1,114 patients with a baseline Lung-RADS score of 1 or 2 were included. The amount of low-dose CT (LDCT) imaging ordered for LCS increased exponentially from 2021 to 2023; however, a higher percentage of LDCT examinations were ordered via the decentralized approach, with no significant change observed over time (76%, 71%, and 74% in 2021, 2022, and 2023, respectively). Overall adherence was 42%. Within the centralized program, adherence was 74% compared to 34% using a decentralized approach (p <0.001).
IMPLICATIONS
Adherence to annual screening among eligible veterans is greater within a centralized program. Future research aimed at identifying barriers and maximizing adherence to LCS is needed.