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Showing content from https://pubmed.ncbi.nlm.nih.gov/29976189/ below:

New recommendation and coverage of low-dose computed tomography for lung cancer screening: uptake has increased but is still low

doi: 10.1186/s12913-018-3338-9. New recommendation and coverage of low-dose computed tomography for lung cancer screening: uptake has increased but is still low

Affiliations

¹ Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA. LiJ14@sutterhealth.org.
² Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA.
³ California Pacific Medical Center Research Institute, Sutter Health Affiliate, 475 Brannan St #220, San Francisco, CA, 94107, USA.

PMID: 29976189
PMCID: PMC6034213
DOI: 10.1186/s12913-018-3338-9

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New recommendation and coverage of low-dose computed tomography for lung cancer screening: uptake has increased but is still low

Jiang Li et al. BMC Health Serv Res. 2018.

doi: 10.1186/s12913-018-3338-9. Affiliations

¹ Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA. LiJ14@sutterhealth.org.
² Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, USA.
³ California Pacific Medical Center Research Institute, Sutter Health Affiliate, 475 Brannan St #220, San Francisco, CA, 94107, USA.

PMID: 29976189
PMCID: PMC6034213
DOI: 10.1186/s12913-018-3338-9

Item in Clipboard

Abstract

Background: In 2013, the US Preventive Services Task Force (USPSTF) issued recommendations for low-dose computed tomography for lung cancer screening (LDCT-LCS), but there continues to be a dearth of information on the adoption of LDCT-LCS in healthcare systems. Using a multilevel perspective, our study aims to assess referrals for LDCT-LCS and identify facilitators and barriers to adoption following recent policy changes.

Methods: A retrospective analysis of electronic medical record data from patients aged 55-80 years with no history of lung cancer who visited a primary care provider in a large healthcare system in California during 2010-2016 (1,572,538 patient years). Trends in documentation of smoking history, number of eligible patients, and lung cancer screening orders were assessed. Using Hierarchical Generalized Linear Models, we also evaluated provider-level and patient-level factors associated with lung cancer screening orders among 970 primary care providers and 12,801 eligible patients according to USPSTF guidelines between January 1st, 2014 and December 31st, 2016.

Results: Documentation of smoking history to determine eligibility (59.2% in 2010 to 77.8% in 2016) and LDCT-LCS orders (0% in 2010 to 7.3% in 2016) have increased since USPSTF guidelines. Patient factors associated with increased likelihood of lung cancer screening orders include: younger patient age (78-80 vs. 55-64 years old: OR, 0.4; 95% CI, 0.3-0.7), Asian race (vs. Non-Hispanic White: OR, 1.6; 95% CI, 1.1-2.4), reported current smoking (vs. former smoker: OR, 1.7; 95% CI, 1.4-2.0), no severe comorbidity (severe vs. no major comorbidity: OR = 0.2, 95% CI = 0.1-0.3; moderate vs. no major comorbidity: OR = 0.5; 95% CI = 0.4-0.7), and making a visit to own primary care provider (vs. other primary care providers: OR, 2.4; 95% CI, 1.7-3.4). Appropriate referral for lung cancer screening varies considerably across primary care providers. Provider factors include being a female physician (vs. male: OR, 1.6; 95% CI, 1.1-2.3) and receiving medical training in the US (foreign vs. US medical school graduates: OR = 0.4, 95% CI = 0.3-0.7).

Conclusions: Future interventions to improve lung cancer screening may be more effective if they focus on accurate documentation of smoking history and target former smokers who do not regularly see their own primary care providers.

Keywords: Cancer prevention and early detection; Health policy change; Implementation; Multilevel analysis; Preventive services.

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Conflict of interest statement Ethics approval and consent to participate

This study was approved by the Sutter Health Institutional Review Board (SHIRB #:2017.033EXP).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures
Fig. 1

Consort diagram for eligibility determination…

Fig. 1

Consort diagram for eligibility determination for low-dose computed tomography for lung cancer screening…

Fig. 1

Consort diagram for eligibility determination for low-dose computed tomography for lung cancer screening (LDCT-LCS)

Fig. 2

Trends in documentation of smoking…

Fig. 2

Trends in documentation of smoking history and referrals of lung cancer screening, 2010–2016

Fig. 2

Trends in documentation of smoking history and referrals of lung cancer screening, 2010–2016

Fig. 3

Average referral rates of lung…

Fig. 3

Average referral rates of lung cancer screening among 663 primary care providers, 2014–2016.…

Fig. 3

Average referral rates of lung cancer screening among 663 primary care providers, 2014–2016. Note: Providers (n = 307) with less than 5 eligible patients during 2014–2016 were excluded