Practical Challenges of Evaluating the Veterans Health Administration (VHA) Lung Cancer Screening Clinical Demonstration Project
*Rebecca B McNeil, Durham VA Medical Center
Keywords: implementation science, program evaluation, electronic medical records, interdisciplinary teams
In 2011, the National Lung Screening Trial (NLST) reported a 20% reduction in mortality associated with participation in a three-year lung cancer screening program using low-dose CT compared to chest radiography among individuals at high risk for lung cancer. Subsequently, the U.S. Preventive Services Task Force (USPSTF) issued a grade B recommendation for annual lung cancer screening in high-risk adults, emphasizing the importance of programmatic implementation. The NLST results prompted the VHA to implement a demonstration project for lung cancer screening in eight VHA medical centers. The evaluation of this project is addressing questions relevant to clinical resource utilization that are critical to the development of VA policies regarding lung cancer screening programs. The program and its evaluation are still in process. We will discuss several aspects of this evaluation, including 1) the challenges of using data from a common electronic medical record platform implemented differently across sites, 2) selecting appropriate comparison groups, 3) challenges resulting from variations in implementation, and 4) the process of integrating perspectives within interdisciplinary teams.