title: Lung Cancer Screening With Low-Dose CT: Implementation Amid Changing Public Policy at One Health Care System.
abstract: Screening for lung cancer with low-dose CT has evolved rapidly in recent years since the National Lung Screening Trial (NLST) results. Subsequent professional and governmental organization guidelines have shaped policy and reimbursement for the service. Increasingly available guidance describes eligible patients and components necessary for a high-quality lung cancer screening program; however, practical instruction and implementation experience is not widely reported. We launched a lung cancer screening program in the face of reimbursement and guideline uncertainties at a large academic health center. We report our experience with implementation, including challenges and proposed solutions. Initially, we saw less referrals than expected for screening, and many patients referred for screening did not clearly meet eligibility guidelines. We educated primary care providers and implemented system tools to encourage referral of eligible patients. Moreover, in response to the Centers for Medicare &amp; Medicaid Services (CMS) final coverage determination, we report our programmatic adaptation to meet these requirements. In addition to the components common to all quality programs, individual health delivery systems will face unique barriers related to patient population, available resources, and referral patterns.
authors.affiliation: From the Department of Medicine, University of Minnesota, Minneapolis, MN; Fairview Health System, University of Minnesota Cancer Care, Minneapolis, MN; Department of Radiology, University of Minnesota, Minneapolis, MN.
authors.forename: Abbie
authors.initials: A
authors.lastname: Begnaud
authors.affiliation: From the Department of Medicine, University of Minnesota, Minneapolis, MN; Fairview Health System, University of Minnesota Cancer Care, Minneapolis, MN; Department of Radiology, University of Minnesota, Minneapolis, MN.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hall
authors.affiliation: From the Department of Medicine, University of Minnesota, Minneapolis, MN; Fairview Health System, University of Minnesota Cancer Care, Minneapolis, MN; Department of Radiology, University of Minnesota, Minneapolis, MN.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Allen
mesh_terms: D055088:Early Detection of Cancer; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006278:Medicare; D011829:Radiation Dosage; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014481:United States