Clinician Variation in Ordering and Completion of Low-Dose Computed Tomography for Lung Cancer Screening in a Safety-Net Medical System

David E. Gerber, Heidi A. Hamann, Olivia Dorsey, Chul Ahn, Jessica L. Phillips, Noel O. Santini, Travis Browning, Cristhiaan D. Ochoa, Joyce Adesina, Vijaya Subbu Natchimuthu, Eric Steen, Harris Majeed, Amrit Gonugunta, Simon J.Craddock Lee

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)e612-e620
JournalClinical Lung Cancer
Volume22
Issue number4
DOIs
StatePublished - Jul 2021

Keywords

  • Adherence
  • Primary care
  • Specialist
  • Underserved
  • Urban

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

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