The Association of Health Care System Resources With Lung Cancer Screening Implementation: A Cohort Study

Area of Science:

• Health Services Research
• Public Health Policy
• Oncology

Background:

• The Veterans Health Administration (VHA) implemented a demonstration project (DP) providing resources for lung cancer screening at eight Veterans Affairs Medical Centers (VAMCs) between 2013 and 2015.
• Lung cancer screening is crucial for early detection and improved outcomes in high-risk populations.

Purpose of the Study:

• To evaluate whether policies providing resources for lung cancer screening increase screening rates among eligible veterans.
• To assess the impact of resource provision on both initial and follow-up lung cancer screening rates.

Main Methods:

• A controlled interrupted time series and difference-in-differences analysis was used, comparing eight DP VAMCs with 20 comparable VAMCs.
• Data spanned three periods: before DP (Jan 2011-Jun 2013), during DP (Jul 2013-Jun 2015), and after DP (Jul 2015-Dec 2018).
• Coprimary outcomes included unique veterans screened per 1,000 eligible per month and those completing a 1-year follow-up screening.

Main Results:

• During the DP, DP VAMCs screened an average of 17.7 unique veterans per 1,000 eligible per month, compared to 0.3 in comparison VAMCs.
• Adjusted analyses showed a significant increase in screening rates at DP VAMCs during the DP (0.93 per 1,000 eligible/month).
• Follow-up screening also increased significantly at DP VAMCs during the DP (0.39 per 1,000 eligible/month), but these gains were not maintained post-DP.

Conclusions:

• The provision of resources for lung cancer screening implementation was associated with a significant increase in screening and follow-up screening rates among veterans.
• The positive impact of the demonstration project on lung cancer screening rates was temporary and not sustained after the resource provision ended.