The Association of Health Care System Resources With Lung Cancer Screening Implementation: A Cohort Study

Jennifer A. Lewis, Lauren R. Samuels, Jason Denton, Michael E. Matheny, Amelia Maiga, Christopher G. Slatore, Eric Grogan, Jane Kim, Robert H. Sherrier, Robert S. Dittus, Pierre P. Massion, Laura Keohane, Christianne L. Roumie, Sayeh Nikpay

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The Veterans Health Administration issued policy for lung cancer screening resources at eight Veterans Affairs Medical Centers (VAMCs) in a demonstration project (DP) from 2013 through 2015. Research Question: Do policies that provide resources increase lung cancer screening rates? Study Design and Methods: Data from eight DP VAMCs (DP group) and 20 comparable VAMCs (comparison group) were divided into before DP (January 2011-June 2013), DP (July 2013-June 2015), and after DP (July 2015-December 2018) periods. Coprimary outcomes were unique veterans screened per 1,000 eligible per month and those with 1-year (9-15 months) follow-up screening. Eligible veterans were estimated using yearly counts and the percentage of those with eligible smoking histories. Controlled interrupted time series and difference-in-differences analyses were performed. Results: Of 27,746 veterans screened, the median age was 66.5 years and most were White (77.7%), male (95.6%), and urban dwelling (67.3%). During the DP, the average rate of unique veterans screened at DP VAMCs was 17.7 per 1,000 eligible per month, compared with 0.3 at comparison VAMCs. Adjusted analyses found a higher rate increase at DP VAMCs by 0.93 screening per 1,000 eligible per month (95% CI, 0.25-1.61) during this time, with an average facility-level difference of 17.4 screenings per 1,000 eligible per month (95% CI, 12.6-22.3). Veterans with 1-year follow-up screening also increased more rapidly at DP VAMCs during the DP, by 0.39 screening per 1,000 eligible per month (95% CI, 0.18-0.60), for an average facility-level difference of 7.2 more screenings per 1,000 eligible per month (95% CI, 5.2-9.2). Gains were not maintained after the DP. Interpretation: In this cohort, provision of resources for lung cancer screening implementation was associated with an increase in veterans screened and those with 1-year follow-up screening. Screening gains associated with the DP were not maintained.

Original languageEnglish (US)
Pages (from-to)701-711
Number of pages11
JournalCHEST
Volume162
Issue number3
DOIs
StatePublished - Sep 2022

Bibliographical note

Funding Information:
Funding/support: This study was supported in part by the Vanderbilt CTSA [Grant UL1 TR000445 ] from National Center for Advancing Translational Sciences at the National Institutes of Health , US Department of Veterans Affairs (VA) Office of Rural Health, VA Office of Academic Affiliations, and the VA National Quality Scholars Program, with resources and use of facilities at VA Tennessee Valley Healthcare System, Nashville, TN, and the VA Portland Health Care System, Portland, OR. The study was also supported in part by a Conquer Cancer The ASCO Foundation Young Investigator Award, 2021YIA9865677411, a LUNGevity Foundation VA Research Scholars Award, 2021-08, the Vanderbilt-Ingram Cancer Center [Grant CA68485 ], and the Vanderbilt Scholars in T4 Translational Research (VSTTaR) K12 Program, funded by the National Heart, Lung, and Blood Institute [Grant K12HL137943 ].

Publisher Copyright:
© 2022

Keywords

  • early detection of cancer
  • implementation
  • lung cancer screening
  • lung neoplasm
  • policy
  • utilization

PubMed: MeSH publication types

  • Journal Article
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

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