TY - JOUR
T1 - Clinician Variation in Ordering and Completion of Low-Dose Computed Tomography for Lung Cancer Screening in a Safety-Net Medical System
AU - Gerber, David E.
AU - Hamann, Heidi A.
AU - Dorsey, Olivia
AU - Ahn, Chul
AU - Phillips, Jessica L.
AU - Santini, Noel O.
AU - Browning, Travis
AU - Ochoa, Cristhiaan D.
AU - Adesina, Joyce
AU - Natchimuthu, Vijaya Subbu
AU - Steen, Eric
AU - Majeed, Harris
AU - Gonugunta, Amrit
AU - Lee, Simon J.Craddock
N1 - Funding Information:
Supported by the Cancer Prevention and Research Institute of Texas (CPRIT; RP160030 and PP190052 to H.A.H. S.J.C.L. C.D.O. and D.E.G.), a National Cancer Institute Midcareer Investigator Award in Patient-Oriented Research (K24CA201543-01 to D.E.G.), and a Mentored Research Scientist Development Award (K01CA234425 to C.D.O.). Additional support was received through the Harold C. Simmons Comprehensive Cancer Center (5P30 CA142543) and UT Southwestern Center for Patient-Centered Outcomes Research (R24 HS022418). The authors thank Dru Gray (UT Southwestern Medical Center) for editorial with document preparation, and Helen Mayo (UT Southwestern Medical Center), MLS, for assistance with literature searches.
Funding Information:
Supported by the Cancer Prevention and Research Institute of Texas (CPRIT; RP160030 and PP190052 to H.A.H., S.J.C.L., C.D.O., and D.E.G.), a National Cancer Institute Midcareer Investigator Award in Patient-Oriented Research ( K24CA201543-01 to D.E.G.), and a Mentored Research Scientist Development Award ( K01CA234425 to C.D.O.). Additional support was received through the Harold C. Simmons Comprehensive Cancer Center ( 5P30 CA142543 ) and UT Southwestern Center for Patient-Centered Outcomes Research ( R24 HS022418 ). The authors thank Dru Gray (UT Southwestern Medical Center) for editorial with document preparation, and Helen Mayo (UT Southwestern Medical Center), MLS, for assistance with literature searches.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/7
Y1 - 2021/7
N2 - Background: Less than 5% of eligible individuals in the United States undergo lung cancer screening. Variation in clinicians’ participation in lung cancer screening has not been determined. Patients and Methods: We studied medical providers who ordered ≥ 1 low-dose computed tomography (LDCT) for lung cancer screening from February 2017 through February 2019 in an integrated safety-net healthcare system. We analyzed associations between provider characteristics and LDCT orders and completion using chi-square, Fisher exact, and Student t tests, as well as ANOVA and multinomial logistic regression. Results: Among an estimated 194 adult primary care physicians, 144 (74%) ordered at least 1 LDCT, as did 39 specialists. These 183 medical providers ordered 1594 LDCT (median, 4; interquartile range, 2-9). In univariate and multivariate models, family practice providers (P < .001) and providers aged ≥ 50 years (P = .03) ordered more LDCT than did other clinicians. Across providers, the median proportion of ordered LDCT that were completed was 67%. The total or preceding number of LDCT ordered by a clinician was not associated with the likelihood of LDCT completion. Conclusion: In an integrated safety-net healthcare system, most adult primary care providers order LDCT. The number of LDCT ordered varies widely among clinicians, and a substantial proportion of ordered LDCT are not completed.
AB - Background: Less than 5% of eligible individuals in the United States undergo lung cancer screening. Variation in clinicians’ participation in lung cancer screening has not been determined. Patients and Methods: We studied medical providers who ordered ≥ 1 low-dose computed tomography (LDCT) for lung cancer screening from February 2017 through February 2019 in an integrated safety-net healthcare system. We analyzed associations between provider characteristics and LDCT orders and completion using chi-square, Fisher exact, and Student t tests, as well as ANOVA and multinomial logistic regression. Results: Among an estimated 194 adult primary care physicians, 144 (74%) ordered at least 1 LDCT, as did 39 specialists. These 183 medical providers ordered 1594 LDCT (median, 4; interquartile range, 2-9). In univariate and multivariate models, family practice providers (P < .001) and providers aged ≥ 50 years (P = .03) ordered more LDCT than did other clinicians. Across providers, the median proportion of ordered LDCT that were completed was 67%. The total or preceding number of LDCT ordered by a clinician was not associated with the likelihood of LDCT completion. Conclusion: In an integrated safety-net healthcare system, most adult primary care providers order LDCT. The number of LDCT ordered varies widely among clinicians, and a substantial proportion of ordered LDCT are not completed.
KW - Adherence
KW - Primary care
KW - Specialist
KW - Underserved
KW - Urban
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UR - http://www.scopus.com/inward/citedby.url?scp=85100150885&partnerID=8YFLogxK
U2 - 10.1016/j.cllc.2020.12.001
DO - 10.1016/j.cllc.2020.12.001
M3 - Article
C2 - 33478912
AN - SCOPUS:85100150885
VL - 22
SP - e612-e620
JO - Clinical Lung Cancer
JF - Clinical Lung Cancer
SN - 1525-7304
IS - 4
ER -