Impact of a Hybrid Lung Cancer Screening Model on Patient Outcomes and Provider Behavior
| Autor: | Melissa L. New, Anna E. Barón, Erin A. Hirsch, Peter B. Sachs, Stephanie L. Brown, Stephen P. Malkoski |
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| Rok vydání: | 2020 |
| Předmět: |
Male
0301 basic medicine Pulmonary and Respiratory Medicine Health Knowledge Attitudes Practice Cancer Research medicine.medical_specialty Lung Neoplasms Health Personnel Population Psychological intervention Specialty Article 03 medical and health sciences 0302 clinical medicine Humans Medicine Lung cancer education Referral and Consultation Early Detection of Cancer Reimbursement Aged Retrospective Studies education.field_of_study Models Statistical integumentary system business.industry Middle Aged Prognosis medicine.disease 030104 developmental biology Oncology 030220 oncology & carcinogenesis Family medicine Practice Guidelines as Topic Female Program Design Language business Medicaid Lung cancer screening Follow-Up Studies |
| Zdroj: | Clin Lung Cancer |
| ISSN: | 1525-7304 |
| DOI: | 10.1016/j.cllc.2020.05.018 |
| Popis: | Background Lung cancer screening (LCS) implementation is complicated by the Centers for Medicare and Medicaid Services reimbursement requirements of shared decision-making and tobacco cessation counseling. LCS programs can utilize different structures to meet these requirements, but the impact of programmatic structure on provider behavior and screening outcomes is poorly described. Patients and Methods In a retrospective chart review of 624 patients in a hybrid structure, academic LCS program, we compared characteristics and outcomes of primary care provider (PCP)- and specialist-screened patients. We also assessed the impact of the availability of an LCS specialty clinic and best practice advisory (BPA) on PCP ordering patterns using electronic medical record generated reports. Results During the study period of July 1, 2014 through June 30, 2018, 48% of patients were specialist-screened and 52% were PCP-screened; there were no clinically relevant differences in patient characteristics or screening outcomes between these populations. PCPs demonstrate distinct practice patterns when offered the choice of specialist-driven or PCP-driven screening. Increased exposure to a LCS BPA is associated with increased PCP screening orders. The addition of a nurse navigator into the LCS program increased documentation of shared decision-making and tobacco cessation counseling to > 95% and virtually eliminated screening of ineligible patients. Conclusions Systematic interventions including a BPA and nurse navigator are associated with increased screening and improved program quality, as evidenced by reduced screening of ineligible patients, increased lung cancer risk of the screened population, and improved compliance with LCS guidelines. Individual PCPs demonstrate clear preferences regarding LCS that should be considered in program design. |
| Databáze: | OpenAIRE |
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