"We don't get that information right back to us unless it's a full-blown cancer": Challenges coordinating lung cancer screening across healthcare systems.

Autor: Bolton RE; VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA., Núñez ER; VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA.; Department of Healthcare Delivery and Population Health Sciences, University of Massachusetts Chan Medical School - Baystate, Springfield, Massachusetts, USA., Boudreau J; VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA., Kearney LM; VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA.; The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA., Ryan SK; VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA., Herbst A; VA Bedford Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA., Slatore C; Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA.; Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, Oregon, USA., Wiener RS; VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research, Boston, Massachusetts, USA.; The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA.; National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA.
Jazyk: angličtina
Zdroj: Health services research [Health Serv Res] 2024 Oct 07. Date of Electronic Publication: 2024 Oct 07.
DOI: 10.1111/1475-6773.14384
Abstrakt: Objective: To examine how lung cancer screening (LCS) is coordinated across healthcare systems, specifically Veterans Affairs (VA) and non-VA settings.
Data Sources and Study Setting: We conducted primary qualitative data collection in six VA medical centers with established LCS programs from November 2020 to November 2021.
Study Design and Data Collection Methods: Semi-structured interviews were conducted with 48 primary care providers, LCS program coordinators and directors, and pulmonologists. Thematic analysis examined spontaneously raised narratives related to initiating and coordinating LCS for Veterans screened in non-VA settings. We mapped coordination challenges to each step of the LCS care continuum.
Principal Findings: While non-VA options increased access to LCS for Veterans, VA medical centers lacked clear processes for initiating LCS referrals and tracking Veterans across the LCS continuum when screening occurred in non-VA settings. The responsibility of coordinating LCS with community providers often fell to VA primary care providers rather than LCS programs. Gaps in communication and data transfer contributed to delayed evaluation of potentially cancerous nodules post-screening, raising concerns about compromised care quality when LCS was shared with non-VA settings.
Conclusions: While policies expanding LCS for Veterans in non-VA settings increase access, lack of consistent processes to initiate referrals, obtain results, and promote timely downstream evaluation fragmented care and delayed evaluation of concerning nodules. These unintended consequences highlight a need to address cross-system coordination challenges. Strategies to better coordinate LCS between VA and non-VA settings are essential to achieve high quality LCS and prevent Veterans from falling through the cracks.
(Published 2024. This article is a U.S. Government work and is in the public domain in the USA. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)
Databáze: MEDLINE
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