Research published online in Clinical Lung Cancer showed that a hybrid care approach for lung cancer screenings (LCS), including best practice advisory (BPA) on PCP ordering patterns using electronic medical record generated reports and a nurse navigator, increased screening rates for this patient population. (Clin Lung Cancer. 2020;S1525-7304(20)30158-3. doi:10.1016/j.cllc.2020.05.018)
“[LCS] implementation is complicated by the Centers for Medicare and Medicaid Services reimbursement requirements of shared decision-making and tobacco cessation counseling,” study authors explained.
According to the study, although LCS programs may use different structures to meet these reimbursement requirements, the impact of programmatic structure on provider behavior and screening outcomes is poorly described.
To better understand provider behavior and screening outcomes, a team of researchers conducted a retrospective chart review of 624 patients. Using a hybrid structure and academic LCS program, the research team compared characteristics and outcomes of primary care provider (PCP)- and specialist-screened patients. Additionally, the study team assessed the impact of the availability of an LCS specialty clinic and BPA on PCP ordering patterns using electronic medical record generated reports.
During the study, which was between July 1, 2014 through June 20, 2018, 48% of patients were specialist-screened and 52% were PCP-screened. The research team found no clinically relevant differences in patient characteristics or screening outcomes between these populations.
“PCPs demonstrate distinct practice patterns when offered the choice of specialist-driven or PCP-driven screening. Increased exposure to a LCS BPA is associated with increased PCP screening orders,” the study team explained.
When a nurse navigator was included in the LCS program, the researchers found there was increased documentation of shared decision-making and tobacco cessation counseling to more than 95% of patients, and they also virtually eliminated screening of ineligible patients.
“Systematic interventions including a BPA and nurse navigator are associated with increased screening and improved program quality, as evidenced by reduced screening of ineligible patients, increased lung cancer risk of the screened population, and improved compliance with LCS guidelines,” study authors concluded. “Individual PCPs demonstrate clear preferences regarding LCS that should be considered in program design.”—Julie Gould
