3096 — Organizational Readiness to Implement a National Lung Cancer Screening Program within the VHA

Sperber NR, Durham COIN; King HA, Durham COIN; Provenzale D, Cooperative Studies Program Epidemiology Center - Durham; Kinsinger L, National Center for Health Promotion and Disease Prevention; Barnes LK, Cooperative Studies Program Epidemiology Center - Durham; Grubber JM, Durham COIN; Larson M, National Center for Health Promotion and Disease Prevention; McNeil RB, Cooperative Studies Program Epidemiology Center - Durham; Wu RR, Durham COIN; Jackson GL, Durham COIN

Objectives:
To identify common and variable aspects of organizational readiness that might impact uptake of low-dose CT (LDCT) lung cancer screening nationally by diverse VHA facilities.

Methods:
We used a realist evaluation approach to identify what works, for whom and how, with data collection and analysis informed by theory (Weiner, 2009) and obtained with multiple methods (observation, interview, and survey). Observation: Evaluators developed case memos on early program implementation factors at each site (N = 8) from participation in NCP-led project phone meetings with site-based project leads and coordinators. Interview: Two evaluators conducted 30-minute semi-structured individual telephone interviews with project leads and coordinators (N = 14). Interview notes were organized in templates with headings mapped to theoretical constructs; these coded data were aggregated into facility-level summaries to identify themes. Survey: Open-ended questions on implementation activities from three electronic monthly reports, completed by sites during the same time frame, were reviewed and categorized.

Results:
Ongoing education about evidence is critical for facility engagement at early implementation. Perceived availability of the following resources were key to interviewees' confidence in their facility's ability to implement: IT support personnel, sufficient radiology staff and scanners, and a site-based coordinator. Participants said that ability to adapt electronic tools, e.g. tracking database, to local practices would be important. Individuals at five sites that had a nodule tracking system in place expressed greater confidence in their facility's ability to implement. A culture of cross-disciplinary communication, for example with implementers already part of a multi-disciplinary thoracic group, was facilitative.

Implications:
This evaluation revealed components likely important for national dissemination of LDCT lung cancer screening across the VHA, including continuing education and key resources. Additionally, some flexibility may be necessary, for example adaptation of IT tools. Contextual factors, like cross-disciplinary communication and a pre-existing tracking system, should be capitalized on in dissemination.

Impacts:
A national program of lung cancer screening with LDCT requires standardization for quality control. However, to facilitate uptake, it is also necessary to consider local variability in readiness. Findings may be used to develop strategies grounded in real-world experiences to facilitate dissemination and implementation of lung cancer screening within the VHA.