MOASIC: Mobile lung Screening evaluation and outComes

Ralph H Johnson Va Medical Center, Charleston SC

Investigators

Abstract

Background: Lung cancer kills more Veterans annually than the next three cancers combined. Lung cancer screening (LCS) with low-dose CT reduces lung cancer mortality through early detection, yet only 2.8% of eligible Veterans have been screened. The Lung Precision Oncology Program (LPOP) was developed to expand the availability of high quality LCS across the VA enterprise. Through our work done through a QUERI Rapid Project Proposal and that of others, drive time distance to a VA CT scanner has been shown to be a barrier to LCS, especially for rural Veterans. VISNs 7 and 9 will be implementing mobile LCS (mLCS) to address this known barrier. We hypothesize that mLCS will increase LCS reach including 1) the proportion of Veterans offered LCS by providers, 2) uptake of LCS among eligible Veterans, and 3) adherence to recommended follow-up LCS among Veterans utilizing mLCS. Significance: This evaluation will determine the impact of mLCS on the offering, acceptance, and adherence to LCS by eligible Veterans. Identify facilitators and barriers to mLCS implementation and determine start up, maintenance and overall cost efficacy. Innovation & Impact: The evaluation of implementation of mLCS in the Veterans Health Administration (VHA) is innovative and will inform mLCS implementation for other VHA sites and beyond VHA. Understanding provider and Veteran perceptions of mLCS, barriers and facilitators to implementation, estimates of Veteran demand, and best technology practices will provide valuable information to be included in a checklist for replication and implementation across VHA. Ultimately this will impact and ensure mortality reduction of lung cancer through early detection. Specific Aims: 1. Pre-implementation: Understand the development of mLCS, assess provider staff perceptions, anticipated barriers and facilitators to implementation, and engage Veterans to optimize implementation and messaging.2. Implementation Outcomes: Conduct a mixed-methods evaluation of the reach (offering, uptake, and adherence) and acceptability of mLCS implementation. 3. Clinical/Health Outcomes: Evaluate the clinical impact of and satisfaction with mLCS on the offering of, acceptance by, and adherence to LCS by eligible Veterans. 4. Economic impacts: Assess start-up and continuing costs of mLCS programs including implementation support costs and compare cost of mLCS compared to traditional care and community care. Methodology: A mixed methods approach to the planning, delivery and evaluation (formative and summative) of mLCS implementation is proposed. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework will be used for planning and summative evaluation. In addition, the Practical Robust Implementation and Sustainability Model (PRISM) will be utilized for formative evaluation at each Community-Based Outpatient Clinic (CBOC) location utilizing mLCS. Data will be collected through quantitative and qualitative assessments including surveys and interviews of providers/staff and the corporate data warehouse. Change in proportion of eligible Veterans offered, accepting, and adherent to LCS prior to and after implementation of mLCS. Results will be characterized for the overall cohort of Veterans pursuing mLCS and stratified by distance traveled for screening. Next Steps/Implementation: Our research team will partner with key stakeholders to create a checklist of resources needed and steps to take to gain support, fund, and implement mLCS that will serve to assist other VA VISNs and facilities considering mLCS. We will partner with Veteran stakeholders to identify the best way to message mLCS to optimize implementation.