Comparing rates of follow-up imaging for lung cancer screening (lcs) in centralized and decentralized clinics

SESSION TITLE: Enhancing Care in Lung Cancer SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm PURPOSE: The Baltimore Veterans Affairs Medical Center (BVAMC) and the University of Maryland Medical Center (UMMC) have adopted LCS programs led by the same physician. We investigated outcomes at each center, evaluating differences in follow up imaging completion within the appropriate time frame (within 2 months of recommended follow up), as indicated based on reported LungRADs score. Specifically, we sought to stratify rates of follow up based on LungRADs scores, comparing outcomes between a centralized single payor clinic (BVAMC) and a multiple payor tertiary referral center (UMMC). METHODS: We performed a retrospective case control study comparing outcomes in patients referred for LCS, in both centralized and decentralized screening cohorts. The centralized LCS model is consult-based in which the consult team determines and verifies patient eligibility, and orders and tracks all low-dose computed tomography scans (LDCT). In a decentralized model, anyone can order LDCT, some of which come to the attention of the LCS program. We identified patients having undergone LDCT for LCS between December 2017 and November 2021 at BVAMC and UMMC. We collected demographic data including age, race, BMI (Body Mass Index), education level, personal cancer history, family history of lung cancer, tobacco exposure history, initial LungRADs findings, and follow up scan dates. RESULTS: 72 BVAMC patients and 70 UMMC patients met the inclusion criteria. The BVAMC cohort was 93% male with an average age of 64. The UMMC cohort was 38% male with an average age of 71. 53% of the BVAMC cohort followed up appropriately compared to 30% of the UMMC cohort. Of the patients with an initial positive LDCT reported as LungRADs 3 or 4, 80% of the VA patients completed appropriate follow up, whereas 29% of UMMC patients completed appropriate follow up. CONCLUSIONS: In this study, there were higher overall rates of follow-up at BVAMC, and higher rates of follow-up when comparing high-risk patients with initial positive scans, LungRADs 3 or 4. Rates of appropriate follow up at BVAMC compared to UMMC may have been improved by more contact with the patients (phone calls, reminders, letters, LCS navigator), in a centralized clinic. This study is limited by skewed patient demographics heavily favoring men in the BVAMC cohort and a small sample size. Further, when comparing rates of follow up, the unintended impact from the Covid-19 pandemic on LDCT follow must be considered. CLINICAL IMPLICATIONS: Follow up imaging, as defined by the American College of Radiology, for lung cancer screening is vitally important. Healthcare optimization to improve rates of follow up may include implementation of a centralized lung cancer screening clinic. DISCLOSURES: No disclosure on file for Max An No relevant relationships by Janaki Deepak No relevant relationships by William Grier No relevant relationships by Allison Herring No relevant relationships by Kendall Klein No relevant relationships by Allison LaRocco No relevant relationships by Ashley Park No relevant relationships by Hussain Siddiqi No disclosure on file for Danielle Soldin No relevant relationships by Adam Starkman No relevant relationships by Avelino Verceles