Tags

Type your tag names separated by a space and hit enter

Real-world Clinical Implementation of Lung Cancer Screening-Evaluating Processes to Improve Screening Guidelines-Concordance.

Abstract

BACKGROUND

Lung cancer screening (LCS) requires complex processes to identify eligible patients, provide appropriate follow-up, and manage findings. It is unclear whether LCS in real-world clinical settings will realize the same benefits as the National Lung Screening Trial (NLST).

OBJECTIVE

To evaluate the impact of process modifications on compliance with LCS guidelines during LCS program implementation, and to compare patient characteristics and outcomes with those in NLST.

DESIGN

Retrospective cohort study.

SETTING

Kaiser Permanente Colorado (KPCO), a non-profit integrated healthcare system.

PATIENTS

A total of 3375 patients who underwent a baseline lung cancer screening low-dose computed tomography (S-LDCT) scan between May 2014 and June 2017.

MEASUREMENTS

Among those receiving an S-LDCT, proportion who met guidelines-based LCS eligibility criteria before and after LCS process modifications, differences in patient characteristics and outcomes between KPCO LCS patients and the NLST cohort, and factors associated with a positive screen.

RESULTS

After modifying LCS eligibility confirmation processes, patients receiving S-LDCT who met guidelines-based LCS eligibility criteria increased from 45.6 to 92.7% (P < 0.001). Prior to changes, patients were older (68 vs. 67 years; P = 0.001), less likely to be current smokers (51.3% vs. 52.5%; P < 0.001), and less likely to have a ≥ 30-pack-year smoking history (50.0% vs. 95.3%; P < 0.001). Compared with NLST participants, KPCO LCS patients were older (67 vs. 60 years; P < 0.001), more likely to currently smoke (52.3% vs. 48.1%; P < 0.001), and more likely to have pulmonary disease. Among those with a positive baseline S-LDCT, the lung cancer detection rate was higher at KPCO (9.4% vs. 3.8%; P < 0.001) and was positively associated with prior pulmonary disease.

CONCLUSION

Adherence to LCS guidelines requires eligibility confirmation procedures. Among those with a positive baseline S-LDCT, comorbidity burden and lung cancer detection rates were notably higher than in NLST, suggesting that the study of long-term outcomes in patients undergoing LCS in real-world clinical settings is warranted.

Authors+Show Affiliations

Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA. nikki.m.carroll@kp.org.Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.Colorado Permanente Medical Group, Kaiser Permanente Colorado, Denver, CO, USA.Colorado Permanente Medical Group, Kaiser Permanente Colorado, Denver, CO, USA.Kaiser Foundation Health Plan, Kaiser Permanente Colorado, Denver, CO, USA.Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31974902

Citation

Carroll, Nikki M., et al. "Real-world Clinical Implementation of Lung Cancer Screening-Evaluating Processes to Improve Screening Guidelines-Concordance." Journal of General Internal Medicine, 2020.
Carroll NM, Burnett-Hartman AN, Joyce CA, et al. Real-world Clinical Implementation of Lung Cancer Screening-Evaluating Processes to Improve Screening Guidelines-Concordance. J Gen Intern Med. 2020.
Carroll, N. M., Burnett-Hartman, A. N., Joyce, C. A., Kinnard, W., Harker, E. J., Hall, V., ... Ritzwoller, D. P. (2020). Real-world Clinical Implementation of Lung Cancer Screening-Evaluating Processes to Improve Screening Guidelines-Concordance. Journal of General Internal Medicine, doi:10.1007/s11606-019-05539-w.
Carroll NM, et al. Real-world Clinical Implementation of Lung Cancer Screening-Evaluating Processes to Improve Screening Guidelines-Concordance. J Gen Intern Med. 2020 Jan 23; PubMed PMID: 31974902.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Real-world Clinical Implementation of Lung Cancer Screening-Evaluating Processes to Improve Screening Guidelines-Concordance. AU - Carroll,Nikki M, AU - Burnett-Hartman,Andrea N, AU - Joyce,Caroline A, AU - Kinnard,William, AU - Harker,Eric J, AU - Hall,Virginia, AU - Steiner,Julie S, AU - Blum-Barnett,Erica, AU - Ritzwoller,Debra P, Y1 - 2020/01/23/ PY - 2019/03/11/received PY - 2019/10/18/accepted PY - 2019/10/18/revised PY - 2020/1/25/entrez PY - 2020/1/25/pubmed PY - 2020/1/25/medline KW - National Lung Screening Trial KW - lung cancer screening implementation JF - Journal of general internal medicine JO - J Gen Intern Med N2 - BACKGROUND: Lung cancer screening (LCS) requires complex processes to identify eligible patients, provide appropriate follow-up, and manage findings. It is unclear whether LCS in real-world clinical settings will realize the same benefits as the National Lung Screening Trial (NLST). OBJECTIVE: To evaluate the impact of process modifications on compliance with LCS guidelines during LCS program implementation, and to compare patient characteristics and outcomes with those in NLST. DESIGN: Retrospective cohort study. SETTING: Kaiser Permanente Colorado (KPCO), a non-profit integrated healthcare system. PATIENTS: A total of 3375 patients who underwent a baseline lung cancer screening low-dose computed tomography (S-LDCT) scan between May 2014 and June 2017. MEASUREMENTS: Among those receiving an S-LDCT, proportion who met guidelines-based LCS eligibility criteria before and after LCS process modifications, differences in patient characteristics and outcomes between KPCO LCS patients and the NLST cohort, and factors associated with a positive screen. RESULTS: After modifying LCS eligibility confirmation processes, patients receiving S-LDCT who met guidelines-based LCS eligibility criteria increased from 45.6 to 92.7% (P < 0.001). Prior to changes, patients were older (68 vs. 67 years; P = 0.001), less likely to be current smokers (51.3% vs. 52.5%; P < 0.001), and less likely to have a ≥ 30-pack-year smoking history (50.0% vs. 95.3%; P < 0.001). Compared with NLST participants, KPCO LCS patients were older (67 vs. 60 years; P < 0.001), more likely to currently smoke (52.3% vs. 48.1%; P < 0.001), and more likely to have pulmonary disease. Among those with a positive baseline S-LDCT, the lung cancer detection rate was higher at KPCO (9.4% vs. 3.8%; P < 0.001) and was positively associated with prior pulmonary disease. CONCLUSION: Adherence to LCS guidelines requires eligibility confirmation procedures. Among those with a positive baseline S-LDCT, comorbidity burden and lung cancer detection rates were notably higher than in NLST, suggesting that the study of long-term outcomes in patients undergoing LCS in real-world clinical settings is warranted. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/31974902/Real-world_Clinical_Implementation_of_Lung_Cancer_Screening-Evaluating_Processes_to_Improve_Screening_Guidelines-Concordance L2 - https://dx.doi.org/10.1007/s11606-019-05539-w DB - PRIME DP - Unbound Medicine ER -