Determining organizational structures and processes that improve lung cancer screening adherence among underserved populations

项目摘要/摘要 肺癌仍然是癌症死亡的主要原因，每年估计有180万人死亡 全世界。少数族裔受到的影响不成比例，因为他们更有可能受到 贫穷，没有保险，在肺癌治疗方面存在差异。肺癌筛查(LCS) 通过密切跟踪和坚持管理，可以将肺癌死亡率降低20% 建议。然而，如何在具有不同背景的现实世界人口中优化LCS遵守 而访问LCS的障碍是未知的。在我们最近的研究中，我们发现在28,294人的全国队列中 接受最初LCS的退伍军人中，只有63%的人在预期时间内收到了建议的下一步 框架，在脆弱人群中更有可能延迟或缺席后续行动，包括退伍军人 种族黑人，有精神健康并存，收入较低或有较高的共同支付 关心。令人鼓舞的是，在大容量LC或学术设施接受护理的退伍军人不太可能 推迟或缺席后续行动，这表明可以从这些LCS方案中吸取教训。我 提出两个基本步骤，以加强我们对肺癌筛查障碍和 制定战略以缩小差距：1)评估退伍军人管理局设施的现有结构和流程 通过开发和管理调查来执行旨在支持公平遵守LCS的LCS 这些设施和2)进行分层多变量回归模型，以确定遵守的障碍 以及在总体上和弱势群体中与更大的LCS后续行动相关的战略 人口。这项工作是确定最佳实践以改进LCS遵从性的关键第一步 并最终缓解肺癌在弱势人群中的差异。这项工作将为下一步的工作提供参考 在我的职业发展中，我将制定一个量身定做的实施计划，然后进行试点 在人口多样化的地点进行实施/有效性研究，以提高LCS带来的死亡率收益。

PROJECT SUMMARY/ABSTRACT Lung cancer remains the leading cause of cancer death, with an estimated 1.8 million deaths annually worldwide. Racial and ethnic minorities are disproportionately affected as they are more likely to be impoverished, lack insurance, and suffer disparities in treatment of lung cancer. Lung cancer screening (LCS) can reduce lung cancer mortality by 20% with close follow-up and adherence to management recommendations. Yet, how to optimize LCS adherence in a real-world population with diverse backgrounds and barriers to accessing LCS is unknown. In our recent work, we found that in a national cohort of 28,294 Veterans who underwent initial LCS, only 63% received the recommended next step in the expected time frame, with delayed or absent follow-up more likely in vulnerable populations, including Veterans who were racially Black, had mental health comorbidities, earned lower income or had higher copayments to access care. Encouragingly, Veterans who received care at high-volume LCS or academic facilities were less likely to have delayed or absent follow-up, suggesting that lessons could be learned from these LCS programs. I propose two foundational steps to enhance our understanding of the barriers to lung cancer screening and develop strategies to mitigate disparities: 1) evaluate the current structures and processes at VA facilities performing LCS designed to support equitable adherence to LCS by developing and administering surveys to these facilities and 2) conduct hierarchical multivariable regression models to identify barriers to adherence and strategies that are associated with greater in LCS follow-up overall, and among subgroups of vulnerable populations. This work represents a critical first step to identify best practices to improve adherence to LCS and ultimately mitigate lung cancer disparities among vulnerable population. This work will inform the next step in my career development, in which I will develop a tailored implementation plan and then a pilot implementation / effectiveness study in a site with a diverse population to improve mortality benefits from LCS.