Leah M Backhus1, Farhood Farjah2, Thomas K Varghese2, Aaron M Cheng2, Xiao-Hua Zhou2, Douglas E Wood2, Larry Kessler2, Steven B Zeliadt2. 1. Leah M. Backhus, Xiao-Hua Zhou, and Steven B. Zeliadt, Veterans Affairs Puget Sound Health Care System; and Leah M. Backhus, Farhood Farjah, Thomas K. Varghese, Aaron M. Cheng, Douglas E. Wood, Larry Kessler, and Steven B. Zeliadt, University of Washington, Seattle, WA. lbackhus@u.washington.edu. 2. Leah M. Backhus, Xiao-Hua Zhou, and Steven B. Zeliadt, Veterans Affairs Puget Sound Health Care System; and Leah M. Backhus, Farhood Farjah, Thomas K. Varghese, Aaron M. Cheng, Douglas E. Wood, Larry Kessler, and Steven B. Zeliadt, University of Washington, Seattle, WA.
Abstract
PURPOSE: Optimizing evidence-based care to improve quality is a critical priority in the United States. We sought to examine adherence to imaging guideline recommendations for staging in patients with locally advanced lung cancer in a national cohort. METHODS: We identified 3,808 patients with stage IIB, IIIA, or IIIB lung cancer by using the national Department of Veterans Affairs (VA) Central Cancer Registry (2004-2007) and linked these patients to VA and Medicare databases to examine receipt of guideline-recommended imaging based on National Comprehensive Cancer Network and American College of Radiology Appropriateness Criteria. Our primary outcomes were receipt of guideline-recommended brain imaging and positron emission tomography (PET) imaging. We also examined rates of overuse defined as combined use of bone scintigraphy (BS) and PET, which current guidelines recommend against. All imaging was assessed during the period 180 days before and 180 days after diagnosis. RESULTS: Nearly 75% of patients received recommended brain imaging, and 60% received recommended PET imaging. Overuse of BS and PET occurred in 25% of patients. More advanced clinical stage and later year of diagnosis were the only clinical or demographic factors associated with higher rates of guideline-recommended imaging after adjusting for covariates. We observed considerable regional variation in recommended PET imaging and overuse of combined BS and PET. CONCLUSION: Receipt of guideline-recommended imaging is not universal. PET appears to be underused overall, whereas BS demonstrates continued overuse. Wide regional variation suggests that these findings could be the result of local practice patterns, which may be amenable to provider education efforts such as Choosing Wisely.
PURPOSE: Optimizing evidence-based care to improve quality is a critical priority in the United States. We sought to examine adherence to imaging guideline recommendations for staging in patients with locally advanced lung cancer in a national cohort. METHODS: We identified 3,808 patients with stage IIB, IIIA, or IIIB lung cancer by using the national Department of Veterans Affairs (VA) Central Cancer Registry (2004-2007) and linked these patients to VA and Medicare databases to examine receipt of guideline-recommended imaging based on National Comprehensive Cancer Network and American College of Radiology Appropriateness Criteria. Our primary outcomes were receipt of guideline-recommended brain imaging and positron emission tomography (PET) imaging. We also examined rates of overuse defined as combined use of bone scintigraphy (BS) and PET, which current guidelines recommend against. All imaging was assessed during the period 180 days before and 180 days after diagnosis. RESULTS: Nearly 75% of patients received recommended brain imaging, and 60% received recommended PET imaging. Overuse of BS and PET occurred in 25% of patients. More advanced clinical stage and later year of diagnosis were the only clinical or demographic factors associated with higher rates of guideline-recommended imaging after adjusting for covariates. We observed considerable regional variation in recommended PET imaging and overuse of combined BS and PET. CONCLUSION: Receipt of guideline-recommended imaging is not universal. PET appears to be underused overall, whereas BS demonstrates continued overuse. Wide regional variation suggests that these findings could be the result of local practice patterns, which may be amenable to provider education efforts such as Choosing Wisely.
Authors: James G Ravenel; Tan-Lucien H Mohammed; Benjamin Movsas; Mark E Ginsburg; Jacobo Kirsch; Feng-Ming Kong; J Anthony Parker; Gautham P Reddy; Kenneth E Rosenzweig; Anthony G Saleh Journal: J Thorac Imaging Date: 2010-11 Impact factor: 3.000
Authors: Natalie Coburn; Raymond Przybysz; Lisa Barbera; David C Hodgson; Andreas Laupacis; Calvin Law Journal: Clin Imaging Date: 2011 Jul-Aug Impact factor: 1.605
Authors: Catherine C Roberts; Richard H Daffner; Barbara N Weissman; Laura Bancroft; D Lee Bennett; Judy S Blebea; Michael A Bruno; Ian Blair Fries; Isabelle M Germano; Langston Holly; Jon A Jacobson; Jonathan S Luchs; William B Morrison; Jeffrey J Olson; William K Payne; Charles S Resnik; Mark E Schweitzer; Leanne L Seeger; Mihra Taljanovic; James N Wise; Stephen T Lutz Journal: J Am Coll Radiol Date: 2010-06 Impact factor: 5.532
Authors: Angela B Mariotto; K Robin Yabroff; Yongwu Shao; Eric J Feuer; Martin L Brown Journal: J Natl Cancer Inst Date: 2011-01-12 Impact factor: 13.506
Authors: Margaret L Crivello; Karen Ruth; Elin R Sigurdson; Brian L Egleston; Kathryn Evers; Yu-Ning Wong; Marcia Boraas; Richard J Bleicher Journal: Ann Surg Oncol Date: 2012-08-10 Impact factor: 5.344
Authors: Yue-Yung Hu; Alvin C Kwok; Wei Jiang; Nathan Taback; Elizabeth T Loggers; Gladys V Ting; Stuart R Lipsitz; Jane C Weeks; Caprice C Greenberg Journal: J Natl Cancer Inst Date: 2012-07-31 Impact factor: 13.506
Authors: Tracy Onega; Tor D Tosteson; Qianfei Wang; Bruce E Hillner; Yunjie Song; Barry A Siegel; Anna N A Tosteson Journal: J Am Coll Radiol Date: 2012-09 Impact factor: 5.532
Authors: Shrujal S Baxi; Minal Kale; Salomeh Keyhani; Benjamin R Roman; Annie Yang; Antonio P Derosa; Deborah Korenstein Journal: Med Care Date: 2017-07 Impact factor: 2.983
Authors: Catherine Byrd; Ureka Ajawara; Ryan Laundry; John Radin; Prasha Bhandari; Ann Leung; Summer Han; Stephen M Asch; Steven Zeliadt; Alex H S Harris; Leah Backhus Journal: BMC Med Inform Decis Mak Date: 2022-06-03 Impact factor: 3.298