Veterans have a high risk of lung cancer and VA is currently implementing CT screening for this population, making it imperative to improve our ability to deliver high quality care to this very large group. After 3 annual screening CT scans, 39% of individuals in a recent lung cancer screening trial had a pulmonary nodule detected that required further evaluation. Our ability to provide Veteran-centric lung cancer screening and pulmonary nodule care is hindered by several gaps in our understanding of the pulmonary nodule evaluation process.
Aim 1: Develop and validate a predictive model of lung cancer risk among a cohort of Veterans with incidentally-detected pulmonary nodules. Rationale: A prognostic model would enable clinicians and patients to improve counseling and access to knowledge by providing personalized, Veteran-centric care outside of specialty settings. Aim 2: Evaluate healthcare system resource utilization amongst a cohort of Veterans with incidentally-detected pulmonary nodules. Rationale: Understanding the resources utilized by Veterans and their clinicians will enable increased safety, efficiency, and standardization which in turn will allow increased access to quality care. Aim 3: Develop and validate an algorithm based on routinely collected clinical data to identify Veterans with a pulmonary nodule diagnosis.
We will conduct a comprehensive review of patients in pulmonary nodule registries at the VA Portland Health Care System and VISN 23 to address these knowledge gaps. These registries are linked to other routinely-collected administrative data and are currently clinically used to track patients with nodules.
Using the smoking status from the electronic health record (EHR) and VHA structured administrative Health Factor data we assessed the validity of using administrative data for determining smoking status. We found that there is substantial agreement between VHA administrative data and EHR records for current, former, and never smoking categories. There also substantial agreement for ever compared with never smoking categories. These kappas are in line with previous administrative data validation studies so these data can be appropriately used for research or clinical purposes. Importantly, targeting lung cancer screening to ever smokers using administrative data would only miss 8% of ever smokers, and only 1% of those are current smokers, so these data may be useful for medical centers implementing LCS.These results were recently presented at the American Thoracic Society conference as an abstract.
There are likely opportunities to improve the utility and safety of the nodule evaluation process which will become crucial when lung cancer CT screening is widely adopted. There is currently no mechanism for using administrative data to identify patients with pulmonary nodules because of a lack of a well-accepted diagnostic code. This information gap substantially hinders the ability of researchers, clinicians, and administrators to efficiently evaluate future screening interventions.
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