title: Implementation of Lung Cancer Screening in the Veterans Health Administration.
abstract: The US Preventive Services Task Force recommends annual lung cancer screening (LCS) with low-dose computed tomography for current and former heavy smokers aged 55 to 80 years. There is little published experience regarding implementing this recommendation in clinical practice.
  
  
  
  To describe organizational- and patient-level experiences with implementing an LCS program in selected Veterans Health Administration (VHA) hospitals and to estimate the number of VHA patients who may be candidates for LCS.
  
  
  
  This clinical demonstration project was conducted at 8 academic VHA hospitals among 93 033 primary care patients who were assessed on screening criteria; 2106 patients underwent LCS between July 1, 2013, and June 30, 2015.
  
  
  
  Implementation Guide and support, full-time LCS coordinators, electronic tools, tracking database, patient education materials, and radiologic and nodule follow-up guidelines.
  
  
  
  Description of implementation processes; percentages of patients who agreed to undergo LCS, had positive findings on results of low-dose computed tomographic scans (nodules to be tracked or suspicious findings), were found to have lung cancer, or had incidental findings; and estimated number of VHA patients who met the criteria for LCS.
  
  
  
  Of the 4246 patients who met the criteria for LCS, 2452 (57.7%) agreed to undergo screening and 2106 (2028 men and 78 women; mean [SD] age, 64.9 [5.1] years) underwent LCS. Wide variation in processes and patient experiences occurred among the 8 sites. Of the 2106 patients screened, 1257 (59.7%) had nodules; 1184 of these patients (56.2%) required tracking, 42 (2.0%) required further evaluation but the findings were not cancer, and 31 (1.5%) had lung cancer. A variety of incidental findings, such as emphysema, other pulmonary abnormalities, and coronary artery calcification, were noted on the scans of 857 patients (40.7%).
  
  
  
  It is estimated that nearly 900 000 of a population of 6.7 million VHA patients met the criteria for LCS. Implementation of LCS in the VHA will likely lead to large numbers of patients eligible for LCS and will require substantial clinical effort for both patients and staff.
authors.affiliation: Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina.
authors.forename: Linda S
authors.initials: LS
authors.lastname: Kinsinger
authors.affiliation: Veterans Health Administration National Radiology Program Office, Durham, North Carolina.
authors.forename: Charles
authors.initials: C
authors.lastname: Anderson
authors.affiliation: Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina.
authors.forename: Jane
authors.initials: J
authors.lastname: Kim
authors.affiliation: Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina.
authors.forename: Martha
authors.initials: M
authors.lastname: Larson
authors.affiliation: Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina.
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Chan
authors.affiliation: Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.|Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Heather A
authors.initials: HA
authors.lastname: King
authors.affiliation: Department of Medicine, Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Rice
authors.affiliation: Department of Medicine, Veterans Affairs Portland Health Care System, Portland, Oregon.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Slatore
authors.affiliation: Department of Medicine, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina.
authors.forename: Nichole T
authors.initials: NT
authors.lastname: Tanner
authors.affiliation: Veterans Health Administration National Center for Health Promotion and Disease Prevention, Durham, North Carolina.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Pittman
authors.affiliation: Pittsburgh Veterans Engineering Resource Center, Pittsburgh, Pennsylvania.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Monte
authors.affiliation: Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.|Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Rebecca B
authors.initials: RB
authors.lastname: McNeil
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Grubber
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.|Veterans Health Administration National Oncology Program, Durham, North Carolina.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kelley
authors.affiliation: Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.|Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Dawn
authors.initials: D
authors.lastname: Provenzale
authors.affiliation: Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.|Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Santanu K
authors.initials: SK
authors.lastname: Datta
authors.affiliation: Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.|Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Nina S
authors.initials: NS
authors.lastname: Sperber
authors.affiliation: Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.
authors.forename: Lottie K
authors.initials: LK
authors.lastname: Barnes
authors.affiliation: Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.
authors.forename: David H
authors.initials: DH
authors.lastname: Abbott
authors.affiliation: Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.
authors.forename: Kellie J
authors.initials: KJ
authors.lastname: Sims
authors.affiliation: Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Whitley
authors.affiliation: Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.|Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: R Ryanne
authors.initials: RR
authors.lastname: Wu
authors.affiliation: Durham Veterans Affairs Health Services Research and Development Center of Innovation, Durham, North Carolina.|Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson
mesh_terms: D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods*; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009936:Organizational Innovation; D000071066:Patient Reported Outcome Measures; D018579:Patient Selection; D011314:Preventive Health Services / Q000379:methods / Q000458:organization & administration / Q000592:standards; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration; D015397:Program Evaluation; D058996:Quality Improvement; D014057:Tomography, X-Ray Computed / Q000379:methods; D014481:United States / Q000453:epidemiology; D058014:Veterans Health / Q000706:statistics & numerical data