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2019 HSR&D/QUERI National Conference Abstract

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1125 — Assessing the Integration of Smoking Cessation During Lung Cancer Screening in VHA

Lead/Presenter: Steven Zeliadt,  COIN - Seattle/Denver
All Authors: Zeliadt S (VA Puget Sound Health Care System, Veterans Health Administration, Seattle, WA), Krebs P (Veterans Health Administration, San Diego, CA), Wheat C (VA Puget Sound Health Care System, Veterans Health Administration, Seattle, WA) Johnson H (University of Washington, Seattle, WA) Feemster L (VA Puget Sound Health Care System, Veterans Health Administration, Seattle, WA) Au D (VA Puget Sound Health Care System, Veterans Health Administration, Seattle, WA) Heffner J (Fred Hutchinson Cancer Research Center, Seattle, WA)

Objectives:
Lung cancer screening (LCS) is now recommended by the US Preventative Services Task Force (USPSTF) and other guideline groups, and national efforts are underway to broadly implement screening. Encouraging cessation among current smokers who are participating in LCS is a critical opportunity to improve health outcomes. The goal of this study was to assess the feasibility of extracting process measures from the VHA electronic health record to assess the provision of smoking cessation treatment to patients undergoing LCS.

Methods:
We identified 67,494 Veterans (95% male) who received LCS from 2014-2018 and were smokers at the time of screening. We performed a cross-sectional analysis of process outcomes occurring near the time of screening, including receipt within 30 days of intensive behavioral counseling ( > 10 minutes) and/or any of 7 types of FDA-approved pharmacotherapies.

Results:
Among current smokers, 13% received cessation pharmacotherapy only, < 1% received counseling only, < 1% received pharmacotherapy plus counseling, and 86% received neither counseling nor pharmacotherapy. The proportion receiving any cessation treatment decreased substantially from 2014 to 2018 (from 18% to 13%), while screening volume increased from 175 smokers/month to over 2600/month during the same time period. Notably, utilization of cessation treatments varied widely across the 82 VHA Medical Centers where LCS was ordered, with 9.2%-30.8% of current smokers undergoing LCS at a given medical center receiving counseling and/or pharmacotherapy.

Implications:
Less than 1% of smokers undergoing LCS in VHA received the most effective form of tobacco treatment: a combination of pharmacotherapy and behavioral intervention. Behavioral treatment was particularly underused. Proportional use of any cessation treatment decreased over time as additional centers began offering screening and volume increased.

Impacts:
Statements: Monitoring process outcomes among screening participants is a feasible approach to assessing the quality of lung cancer screening delivery. The wide variation of smoking cessation services uptake observed across VHA sites suggests that cessation services will not be universally offered without additional intervention. Efforts to increase the utilization of effective cessation treatments are needed to support cessation and increase the value of implementing lung cancer screening in VHA.