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AHRQ Research Studies Date
Topics
- Cancer (16)
- (-) Cancer: Lung Cancer (19)
- Case Study (1)
- Decision Making (3)
- Electronic Health Records (EHRs) (2)
- Evidence-Based Practice (5)
- Guidelines (3)
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- Imaging (5)
- Implementation (2)
- Learning Health Systems (1)
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- Organizational Change (1)
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- Racial and Ethnic Minorities (2)
- Rural/Inner-City Residents (1)
- (-) Screening (19)
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- Urban Health (1)
- Women (1)
- Workflow (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 19 of 19 Research Studies DisplayedBalbin CA, Kawamoto K
The SIMPLE architectural pattern for integrating patient-facing apps into clinical workflows: desiderata and application for lung cancer screening.
To address the need for electronic health record (EHR) systems to accept the connection of any patient-facing digital health app using the SMART on FHIR standard, the authors proposed the Standards-based Implementation Maximizing Portability Leveraging the EHR (SIMPLE). SIMPLE’s architectural pattern was designed to meet several key requirements, such as not requiring patients to install new software; not retaining patient data outside of the EHR; leveraging existing personal health record (PHR) capabilities to optimize user experience; and maximizing portability.
AHRQ-funded; HS028791.
Citation: Balbin CA, Kawamoto K .
The SIMPLE architectural pattern for integrating patient-facing apps into clinical workflows: desiderata and application for lung cancer screening.
AMIA Annu Symp Proc 2024 Jan 11; 2023:844-53..
Keywords: Workflow, Health Information Technology (HIT), Cancer: Lung Cancer, Cancer, Screening
Kukhareva PV, Li H, Caverly TJ
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
The authors conducted pre- and post-intervention analysis in primary care and pulmonary clinics to explore whether clinician-facing electronic health record (EHR) prompts and an EHR-integrated shared decision-making (SDM) tool designed to support incorporation of SDM into primary care could improve low-dose computer tomography scan imaging ordering and completion. Subjects were patients who met US Preventive Services Task Force criteria for lung cancer screening (LCS). The results indicated that EHR prompts and the EHR-integrated SDM tool were promising approaches to improving LCS in the primary care setting. The authors noted that further research is warranted.
AHRQ-funded; HS026198; HS028791.
Citation: Kukhareva PV, Li H, Caverly TJ .
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
Chest 2023 Nov; 164(5):1325-38. doi: 10.1016/j.chest.2023.04.040..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Decision Making
Landy R, Gomez I, Caverly TJ
Methods for using race and ethnicity in prediction models for lung cancer screening eligibility.
The purpose of this study was to compare eligibility for lung cancer screening in a representative United States population by refitting the life-years gained from screening-computed tomography (LYFS-CT) model to exclude race and ethnicity versus a counterfactual eligibility method that recalculates life expectancy for racial and ethnic minority individuals utilizing the same covariates but substitutes White race and utilizes the higher predicted life expectancy, preventing historically underserved groups from being penalized. The National Health Interview Survey (NHIS) 2015-2018 included 25,601 individuals aged 50 to 80 years who ever smoked. The study found that removing race and ethnicity from the submodels underestimated lung cancer death risk and all-cause mortality in African American individuals. It also overestimated mortality in Hispanic American and Asian American individuals. As a result, the LYFS-CT NoRace model increased Hispanic American and Asian American eligibility by 108% and 73%, respectively, while decreasing African American eligibility by 39%. Utilizing LYFS-CT with the counterfactual all-cause mortality model better maintained calibration across groups and increased African American eligibility by 13% without decreasing eligibility for Hispanic American and Asian American individuals.
AHRQ-funded; HS026198.
Citation: Landy R, Gomez I, Caverly TJ .
Methods for using race and ethnicity in prediction models for lung cancer screening eligibility.
JAMA Netw Open 2023 Sep; 6(9):e2331155. doi: 10.1001/jamanetworkopen.2023.31155..
Keywords: Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Screening, Prevention
Lee SJC, Lee J, Zhu H
Assessing barriers and facilitators to lung cancer screening: initial findings from a patient navigation intervention.
This study’s objective was to examine the challenges to providing lung cancer screening using low-dose computed tomography for patients, particularly minority, under-, and uninsured populations. The authors conducted a pragmatic randomized controlled trial of telephone-based navigation for lung cancer screening in an integrated, urban safety-net health care system. They used bilingual navigators (Spanish and English) to make systematic contact with patients, recording standardized call characteristics in a study-specific database. A total of 225 patients (mean age 63 years, 46% female, 70% racial/ethnic minority) were assigned navigators, with a total of 559 barriers to screening identified during 806 telephone calls. The most common barrier types were personal (46%), provider (30%), and practical (17%). System (6%) and psychosocial (1%) barriers were described by English-speaking patients, but not by Spanish-speaking patients. Provider-related barriers decreased by 80% over the course of the lung cancer screening process.
AHRQ-funded; HS022418.
Citation: Lee SJC, Lee J, Zhu H .
Assessing barriers and facilitators to lung cancer screening: initial findings from a patient navigation intervention.
Popul Health Manag 2023 Jun; 26(3):177-84. doi: 10.1089/pop.2023.0053..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Prevention, Imaging
Strayer TE, Spalluto LB, Burns A
Using the framework for reporting adaptations and modifications-expanded (frame) to study adaptations in lung cancer screening delivery in the Veterans Health Administration: a cohort study.
The purpose of this study was to apply the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to study adaptations in lung cancer screening delivery processes in a Veterans Health Administration (VHA) Initiative. Between 2019 and 2021 the researchers prospectively administered semi-structured interviews with lung cancer screening program navigators at 10 Veterans Affairs Medical Centers (VAMCs). Baseline process maps were developed for each program, and each program navigator reviewed process maps in subsequent years 1 and 2. Researchers then identified, documented, and mapped adaptations in screening processes to the FRAME categories. 16 interviews were conducted across 10 VHA lung cancer screening programs, with 6 of these being operational, and of those 3 reported adaptations to their screening processes that were planned or in response to COVID-19. In year 2 all 10 programs were operational and eligible. Programs reported 14 adaptations in year 2. The adaptations identified were both planned and unplanned and often prompted by increased workload; 57% of year 2 adaptations were associated with the identification and eligibility of Veterans and 43% were associated with follow-up with Veterans for screening results. During the 2 years, adaptations associated with data management and patient tracking took place in 60% of programs to improve the data collection and tracking of Veterans in the screening process. The study concluded that adaptations took place predominantly in the categories of patient identification and communication of results due to increased workload.
AHRQ-funded; HS026122; HS026395.
Citation: Strayer TE, Spalluto LB, Burns A .
Using the framework for reporting adaptations and modifications-expanded (frame) to study adaptations in lung cancer screening delivery in the Veterans Health Administration: a cohort study.
Implement Sci Commun 2023 Jan 12; 4(1):5. doi: 10.1186/s43058-022-00388-x..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Evidence-Based Practice, Learning Health Systems
Kukhareva PV, Caverly TJ, Li H
Inaccuracies in electronic health records smoking data and a potential approach to address resulting underestimation in determining lung cancer screening eligibility.
The authors sought to characterize EHR smoking data issues and to propose an approach to addressing these issues using longitudinal smoking data. They found that over 80% of evaluated records had inaccuracies, including missing packs-per-day or years-smoked, outdated data, missing years-quit, and a recent change in packs-per-day resulting in inaccurate lifetime pack-years estimation. Further, addressing these issues by using longitudinal data enabled the identification of 49.4% more patients potentially eligible for lung cancer screening.
AHRQ-funded; HS026198.
Citation: Kukhareva PV, Caverly TJ, Li H .
Inaccuracies in electronic health records smoking data and a potential approach to address resulting underestimation in determining lung cancer screening eligibility.
J Am Med Inform Assoc 2022 Apr 13;29(5):779-88. doi: 10.1093/jamia/ocac020..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Screening, Cancer: Lung Cancer, Cancer
Reese TJ, Schlechter CR, Kramer H
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
This study explored the implementation of lung cancer screening with low-dose computed tomography (CT) in primary care. The study’s two goals included exploring the implementation of lung cancer screening primary care in the context of integrating a decision aid into the electronic health record and a designing of implementation strategies that target hypothesized mechanics of change and context-specific barriers. The two phases included a Qualitative Analysis phase including semi-structured interviews with primary care physicians to elicit key task behaviors, and an Implementation Strategy Design phase consisting of defining implementation strategies and hypothesizing causal pathways to improve screening with a decision aid. Fourteen interviews were conducted and out of that 3 key task behaviors and four behavioral determinants emerged. Strategies included increasing provider self-efficacy toward performing shared decision making and using the decision aid, improving provider performance expectancy, increasing social influence, and addressing key facilitators to using the decision aid.
AHRQ-funded; HS026198.
Citation: Reese TJ, Schlechter CR, Kramer H .
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
Transl Behav Med 2022 Feb 16;12(2):187-97. doi: 10.1093/tbm/ibab115..
Keywords: Cancer: Lung Cancer, Cancer, Primary Care, Screening, Implementation, Decision Making
Tracer H, Pierre J
AHRQ Author: Tracer H
Screening for lung cancer.
This paper is part of the “Putting Prevention into Practice” series. It provides an evidence-based case study related to lung cancer screening. Questions and answers related to the case are included.
AHRQ-authored.
Citation: Tracer H, Pierre J .
Screening for lung cancer.
Am Fam Physician 2021 Jul 1;104(1):79-80..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Lung Cancer, Cancer, Screening, Prevention, Case Study, Evidence-Based Practice
Spalluto LB, Lewis JA, Stolldorf D
Organizational readiness for lung cancer screening: a cross-sectional evaluation at a Veterans Affairs medical center.
Lung cancer has the highest cancer-related mortality in the United States and among Veterans. Screening of high-risk individuals with low-dose CT (LDCT) can improve survival through detection of early-stage lung cancer. Organizational factors that aid or impede implementation of this evidence-based practice in diverse populations are not well described. In this study, the investigators evaluated organizational readiness for change and change valence (belief that change is beneficial and valuable) for implementation of LDCT screening.
AHRQ-funded; HS026395.
Citation: Spalluto LB, Lewis JA, Stolldorf D .
Organizational readiness for lung cancer screening: a cross-sectional evaluation at a Veterans Affairs medical center.
J Am Coll Radiol 2021 Jun;18(6):809-19. doi: 10.1016/j.jacr.2020.12.010..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Implementation, Organizational Change
Hochheimer CJ, Sabo RT, Tong ST
Practice, clinician, and patient factors associated with the adoption of lung cancer screening.
This study sought to assess lung cancer screening uptake in three health systems. Findings showed that certain patients appeared more likely to be screened. Of the three systems studied, the only one with increased lung cancer screening explicitly promoted screening rather than relying on clinicians to implement the new 2013 USPSTF guideline.
AHRQ-funded; HS025032.
Citation: Hochheimer CJ, Sabo RT, Tong ST .
Practice, clinician, and patient factors associated with the adoption of lung cancer screening.
J Med Screen 2021 Jun;28(2):158-62. doi: 10.1177/0969141320937326..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Guidelines
Meza R, Jeon J, Toumazis I
Evaluation of the benefits and harms of lung cancer screening with low-dose computed tomography: modeling study for the US Preventive Services Task Force.
The purpose of this study was to inform the USPSTF guidelines by estimating the benefits and harms associated with various low-dose computed tomography (LDCT) screening strategies. Microsimulation modeling studies suggested that LDCT screening for lung cancer compared with no screening may increase lung cancer deaths averted and life-years gained when optimally targeted and implemented. Screening individuals at aged 50 or 55 years through aged 80 years with 20 pack-years or more of smoking exposure was estimated to result in more benefits than the 2013 USPSTF-recommended criteria and less disparity in screening eligibility by sex and race/ethnicity.
AHRQ-funded; 290201500011I.
Citation: Meza R, Jeon J, Toumazis I .
Evaluation of the benefits and harms of lung cancer screening with low-dose computed tomography: modeling study for the US Preventive Services Task Force.
JAMA 2021 Mar 9;325(10):988-97. doi: 10.1001/jama.2021.1077..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Lung Cancer, Cancer, Imaging, Screening, Prevention, Evidence-Based Practice, Guidelines
Jonas DE, Reuland DS, Reddy SM
Screening for lung cancer with low-dose computed tomography: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to review the evidence on screening for lung cancer with low-dose computed tomography (LDCT) to inform the USPSTF. Findings showed that screening high-risk persons with LDCT can reduce lung cancer mortality but can also cause false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, increases in distress, and, rarely, radiation-induced cancers.
AHRQ-funded; 290201500011I.
Citation: Jonas DE, Reuland DS, Reddy SM .
Screening for lung cancer with low-dose computed tomography: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2021 Mar 9;325(10):971-87. doi: 10.1001/jama.2021.0377..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Lung Cancer, Cancer, Imaging, Screening, Prevention, Evidence-Based Practice
Reese TJ, Schlechter CR, Potter LN
Evaluation of revised US Preventive Services Task Force lung cancer screening guideline among women and racial/ethnic minority populations.
The purpose of this study was to determine the changes associated with the revised USPSTF guideline for lung cancer screening eligibility among female, Black, and Hispanic populations using a large nationwide survey. The investigators concluded that the revised USPSTF guideline may likely increase lung cancer screening rates for female, Black, and Hispanic populations. However, despite these potential improvements, lung cancer screening inequities may persist without tailored eligibility criteria.
AHRQ-funded; HS026198.
Citation: Reese TJ, Schlechter CR, Potter LN .
Evaluation of revised US Preventive Services Task Force lung cancer screening guideline among women and racial/ethnic minority populations.
JAMA Netw Open 2021 Jan;4(1):e2033769. doi: 10.1001/jamanetworkopen.2020.33769..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Lung Cancer, Cancer, Screening, Racial and Ethnic Minorities, Women, Guidelines, Evidence-Based Practice
Gerber DE, Hamann HA, Chavez C
Tracking the nonenrolled: lung cancer screening patterns among individuals not accrued to a clinical trial.
Researchers investigated lung cancer screening patterns among individuals eligible for, but not enrolled in, a screening trial. They found that, in their single-center study, demographic factors did not predict for participation in a lung cancer screening trial; lung cancer screening adherence rates were substantially lower for those not enrolled in a screening trial, especially for those who could not be contacted. The researchers conclude that these findings may inform the broader implementation of screening programs.
AHRQ-funded; HS022418.
Citation: Gerber DE, Hamann HA, Chavez C .
Tracking the nonenrolled: lung cancer screening patterns among individuals not accrued to a clinical trial.
Clin Lung Cancer 2020 Jul;21(4):326-32. doi: 10.1016/j.cllc.2020.02.010..
Keywords: Cancer: Lung Cancer, Cancer, Screening
Lee SJC, Hamann HA, Browning T
Stakeholder engagement to initiate lung cancer screening in an urban safety-net health system.
The authors sought to develop a population-based lung cancer screening program using low-dose computed tomography imaging at Parkland Health & Hospital System, Dallas County, Texas, providing coverage of uninsured patients through a combination of Medicare, Medicaid, and the Dallas medical assistance program for under- and uninsured, low-income county residents. They found that establishing a uniform clinical pathway connecting different clinical specialists requires a system-level view of care coordination to ensure that referrals trigger appointments, result reporting, and follow-up. Additionally, primary care providers need to educate and refer patients, address smoking cessation needs, and document shared decision-making counseling between the referring provider and the patient.
AHRQ-funded; HS022418.
Citation: Lee SJC, Hamann HA, Browning T .
Stakeholder engagement to initiate lung cancer screening in an urban safety-net health system.
Healthc 2020 Mar;8(1):100370. doi: 10.1016/j.hjdsi.2019.100370.
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Keywords: Cancer: Lung Cancer, Cancer, Screening, Prevention, Urban Health, Rural/Inner-City Residents
Roth JA, Carter-Harris L, Brandzel S
A qualitative study exploring patient motivations for screening for lung cancer.
The purpose of this qualitative study was to explore the motivations for screening-eligible patients to screen for lung cancer. The investigators concluded that participants in their study were primarily motivated to screen for lung cancer based on perceived benefit of early-detection, absence of safety concerns, and personal relationships. They suggest that their findings can potentially be used to improve lung cancer screening uptake and shared decision-making processes.
AHRQ-funded; HS022982.
Citation: Roth JA, Carter-Harris L, Brandzel S .
A qualitative study exploring patient motivations for screening for lung cancer.
PLoS One 2018 Jul 5;13(7):e0196758. doi: 10.1371/journal.pone.0196758..
Keywords: Cancer: Lung Cancer, Decision Making, Healthcare Utilization, Screening
Roth JA, Ramsey SD
Computed tomography screening for lung cancer: A high-value proposition?
This study assessed the cost-effectiveness of low-dose computed tomographic scan screening for lung cancer within the Canadian health care system. It found that compared with no screening, the reference scenario saved 51,000 quality-adjusted life-years (QALY) and had an incremental cost-effectiveness ratio of CaD $52,000/QALY.
HS022982.
Citation: Roth JA, Ramsey SD .
Computed tomography screening for lung cancer: A high-value proposition?
JAMA 2016 Jan 5;315(1):77-8. doi: 10.1001/jama.2015.17877..
Keywords: Cancer: Lung Cancer, Imaging, Screening, Healthcare Costs, Quality of Life
Roth JA, Sullivan SD, Goulart BH
Projected clinical, resource use, and fiscal impacts of implementing low-dose computed tomography lung cancer screening in Medicare.
The Centers for Medicare and Medicaid Services (CMS) recently issued a national coverage determination that provides reimbursement for low-dose computed tomography (CT) lung cancer screening for enrollees age 55 to 77 years. This study’s simulation model projected that over 5 years, that low-dose CT screening will result in 10.7 million more low-dose CT scans, 52,000 more lung cancers detected, and increased overall expenditure of $6.8 billion.
AHRQ-funded; HS022982.
Citation: Roth JA, Sullivan SD, Goulart BH .
Projected clinical, resource use, and fiscal impacts of implementing low-dose computed tomography lung cancer screening in Medicare.
J Oncol Pract 2015 Jul;11(4):267-72. doi: 10.1200/jop.2014.002600.
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Keywords: Cancer: Lung Cancer, Screening, Medicare, Healthcare Costs, Healthcare Utilization
Smieliauskas F, MacMahon H, Salgia R
Geographic variation in radiologist capacity and widespread implementation of lung cancer CT screening.
The researchers estimated the prevalence of capacity constraints in the radiologist workforce and resulting potential disparities in access to lung cancer screening. They found that scaling up lung cancer screening would increase imaging procedures by an average of 4% across Health Service Areas (HSAs). HSAs that were rural, with many eligible smokers, and disproportionately Hispanic or low-income smokers had significantly higher odds of facing capacity constraints.
AHRQ-funded; HS018535.
Citation: Smieliauskas F, MacMahon H, Salgia R .
Geographic variation in radiologist capacity and widespread implementation of lung cancer CT screening.
J Med Screen 2014 Dec;21(4):207-15. doi: 10.1177/0969141314548055..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer, Cancer: Lung Cancer, Screening, Imaging