Clinician Variation in Ordering and Completion of Low-Dose Computed Tomography for Lung Cancer Screening in a Safety-Net Medical System.
Clinician Variation in Ordering and Completion of Low-Dose Computed Tomography for Lung Cancer Screening in a Safety-Net Medical System.
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DOI：
10.1016/j.cllc.2020.12.001
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发表时间：
2021-07
影响因子：
3.6
通讯作者：
Lee, Simon J. Craddock
中科院分区：
文献类型：
--
作者：
Gerber, David E.;Hamann, Heidi A.;Dorsey, Olivia;Ahn, Chul;Phillips, Jessica L.;Santini, Noel O.;Browning, Travis;Ochoa, Cristhiaan D.;Adesina, Joyce;Natchimuthu, Vijaya Subbu;Steen, Eric;Majeed, Harris;Gonugunta, Amrit;Lee, Simon J. Craddock
在美国，只有不到5%的符合条件的人接受肺癌筛查。临床医生参与肺癌筛查的差异尚未确定。我们研究了2017年2月至2019年2月在综合安全网医疗保健系统中订购一种或多种低剂量计算机断层扫描（LDCT）进行肺癌筛查的医疗提供者。我们使用卡方检验、Fisher精确检验、Student t检验、ANOVA和多项logistic回归分析了提供者特征与LDCT订单和完成之间的关联。在估计的194名成人初级保健医生中，144名（74%）订购了至少一个LDCT，39名专家也订购了。这183名医疗提供者订购了1，594份LDCT（中位数4;四分位数范围2-9）。在单变量和多变量模型中，家庭医生（P<0.001）和年龄≥50岁的医生（P=0.03）比其他医生订购更多的LDCT。在所有提供者中，完成LDCT的中位数比例为67%。临床医生安排的LDCT的总数或之前的数量与LDCT完成的可能性无关。在综合安全网医疗保健系统中，大多数成人初级保健提供者订购LDCT。LDCT的数量在临床医生之间差异很大，并且很大一部分LDCT没有完成。尽管有证据支持其使用，但肺癌筛查仍然没有得到充分利用。因此，我们确定了与低剂量计算机断层扫描（LDCT）扫描的顺序和完成相关的临床特征。我们发现，大多数的成人初级保健临床医生在一个安全网医疗保健系统订单LDCT，LDCT订购的数量变化很大，并订购LDCT的相当大的比例没有完成。
Fewer than five percent of eligible individuals in the U.S. undergo lung cancer screening. Variation in clinicians’ participation in lung cancer screening has not been determined. We studied medical providers who ordered one or more 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’s exact tests, Student’s t-tests, ANOVA, and multinomial logistic regression Among an estimated 194 adult primary care physicians, 144 (74%) ordered at least one LDCT, as did 39 specialists. These 183 medical providers ordered 1,594 LDCT (median 4; interquartile range 2-9). In univariate and multivariate models, family practice providers (P<0.001) and providers age ≥50 years (P=0.03) 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. 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. Despite evidence supporting its use, lung cancer screening remains underutilized. We therefore determined clinician characteristics associated with ordering and completion of low-dose computed tomography (LDCT) scans. We found that the majority of adult primary care clinicians in a safety-net healthcare system order LDCT, the number of LDCT ordered varies considerably, and a substantial proportion of ordered LDCT are not completed.
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影响因子：
--
作者：
Inadomi, John M.;Vijan, Sandeep;Janz, Nancy K.;Fagerlin, Angela;Thomas, Jennifer P.;Lin, Yunghui V.;Munoz, Roxana;Lau, Chim;Somsouk, Ma;El-Nachef, Najwa;Hayward, Rodney A.
通讯作者：
Hayward, Rodney A.
影响因子：
--
作者：
Henderson, Louise M;Marsh, Mary W;Rivera, M Patricia
通讯作者：
Rivera, M Patricia
影响因子：
158.5
作者：
Bach, PB;Cramer, LD;Begg, CB
通讯作者：
Begg, CB
DOI：
10.1016/j.nurpra.2014.11.004
发表时间：
2015-02-01
期刊：
JNP-JOURNAL FOR NURSE PRACTITIONERS
影响因子：
--
作者：
Barnes, Hilary
通讯作者：
Barnes, Hilary
影响因子：
5.1
作者：
McGregor, SE;Hilsden, RJ;Bryant, HE
通讯作者：
Bryant, HE