Jennifer A Lewis1,2,3, Lauren R Samuels1,4, Jason Denton1,5,6, Gretchen C Edwards1,7, Michael E Matheny1,5,6, Amelia Maiga7, Christopher G Slatore8, Eric Grogan9, Jane Kim10, Robert H Sherrier11, Robert S Dittus1,6, Pierre P Massion3,12,13, Laura Keohane14, Sayeh Nikpay14, Christianne L Roumie1,6. 1. Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA. 2. Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. 3. Vanderbilt Ingram Cancer Center, Nashville, TN, USA. 4. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA. 5. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. 6. Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA. 7. Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 8. Veterans Affairs Portland Health Care System, Center to Improve Veteran Involvement in Care, Pulmonary & Critical Care Medicine, Portland, Oregon. 9. Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 10. Veterans Health Administration, National Center for Health Promotion and Disease Prevention, Durham, NC, USA. 11. Durham VA Health Care System, Radiology, Durham, NC, USA. 12. Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. 13. Department of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN, USA. 14. Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.
Abstract
BACKGROUND: Many Veterans are high risk for lung cancer. Low-dose computed tomography (LDCT) is an effective strategy for lung cancer early detection in a high-risk population. Our objective was to describe and compare annual and geographic utilization trends for LDCT screening in the Veteran's Health Administration (VHA). METHODS: A national retrospective cohort of screened Veterans from January 1, 2011 to May 31, 2018 was used to calculate annual and regional rates of initial LDCT utilization per 1000 eligible Veterans. We identified Veterans with a first LDCT exam using common procedure terminology codes G0297 or 71250 and described as "lung cancer screening," "screening," or "LCS." The number of screen-eligible Veterans per year was calculated as unique Veterans aged 55 to 80 years seen at a Veterans Affairs medical center (VAMC) in that year, multiplied by 32% (estimated proportion with eligible smoking history). We present 95% confidence intervals (CI) for rates. RESULTS: Screened Veterans had a mean age of 66.1 years (standard deviation [SD] = 5.6); 95.5% male; 77.4% Caucasian. There were 119 300 LDCT exams, of which 80 819 (67.7%) were initial. Nationally, initial screens increased from 0 (95% CI = 0.00 to 0.00) in 2011 to 29.6 (95% CI = 29.26 to 29.88) scans per 1000 eligible Veterans in 2018 (Ptrend < .001). Initial screens increased over time within all geographic regions, most prominently in northeastern and Florida VAMCs. CONCLUSION: VHA LDCT utilization increased from 2011 to 2018. However, overall utilization remained low. Future interventions are needed to increase lung cancer screening utilization among eligible Veterans. Published by Oxford University Press 2020.
BACKGROUND: Many Veterans are high risk for lung cancer. Low-dose computed tomography (LDCT) is an effective strategy for lung cancer early detection in a high-risk population. Our objective was to describe and compare annual and geographic utilization trends for LDCT screening in the Veteran's Health Administration (VHA). METHODS: A national retrospective cohort of screened Veterans from January 1, 2011 to May 31, 2018 was used to calculate annual and regional rates of initial LDCT utilization per 1000 eligible Veterans. We identified Veterans with a first LDCT exam using common procedure terminology codes G0297 or 71250 and described as "lung cancer screening," "screening," or "LCS." The number of screen-eligible Veterans per year was calculated as unique Veterans aged 55 to 80 years seen at a Veterans Affairs medical center (VAMC) in that year, multiplied by 32% (estimated proportion with eligible smoking history). We present 95% confidence intervals (CI) for rates. RESULTS: Screened Veterans had a mean age of 66.1 years (standard deviation [SD] = 5.6); 95.5% male; 77.4% Caucasian. There were 119 300 LDCT exams, of which 80 819 (67.7%) were initial. Nationally, initial screens increased from 0 (95% CI = 0.00 to 0.00) in 2011 to 29.6 (95% CI = 29.26 to 29.88) scans per 1000 eligible Veterans in 2018 (Ptrend < .001). Initial screens increased over time within all geographic regions, most prominently in northeastern and Florida VAMCs. CONCLUSION: VHA LDCT utilization increased from 2011 to 2018. However, overall utilization remained low. Future interventions are needed to increase lung cancer screening utilization among eligible Veterans. Published by Oxford University Press 2020.
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