Challenges Implementing Lung Cancer Screening in Federally Qualified Health Centers

Steven B Zeliadt; Richard M Hoffman; Genevieve Birkby; Jan M Eberth; Alison T Brenner; Daniel S Reuland; Susan A Flocke

doi:10.1016/j.amepre.2018.01.001

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Challenges Implementing Lung Cancer Screening in Federally Qualified Health Centers

Journal article

Peer reviewed

Challenges Implementing Lung Cancer Screening in Federally Qualified Health Centers

Steven B Zeliadt, Richard M Hoffman, Genevieve Birkby, Jan M Eberth, Alison T Brenner, Daniel S Reuland and Susan A Flocke

American journal of preventive medicine, Vol.54(4), pp.568-575

04/2018

DOI: 10.1016/j.amepre.2018.01.001

PMCID: PMC8483158

PMID: 29429606

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https://www.ncbi.nlm.nih.gov/pmc/articles/8483158View

Open Access

Abstract

The purpose of this study is to identify issues faced by Federally Qualified Health Centers (FQHCs) in implementing lung cancer screening in low-resource settings. Medical directors of 258 FQHCs serving communities with tobacco use prevalence above the median of all 1,202 FQHCs nationally were sampled to participate in a web-based survey. Data were collected between August and October 2016. Data analysis was completed in June 2017. There were 112 (43%) FQHC medical directors or surrogates who responded to the 2016 survey. Overall, 41% of respondents were aware of a lung cancer screening program within 30 miles of their system's largest clinic. Although 43% reported that some providers in their system offer screening, it was typically at a very low volume (less than ten/month). Although FQHCs are required to collect tobacco use data, only 13% indicated that these data can identify patients eligible for screening. Many FQHCs reported important patient financial barriers for screening, including lack of insurance (72%), preauthorization requirements (58%), and out-of-pocket cost burdens for follow-up procedures (73%). Only 51% indicated having adequate access to specialty providers to manage abnormal findings, and few reported that leadership had either committed resources to lung cancer screening (12%) or prioritized lung cancer screening (12%). FQHCs and other safety-net clinics, which predominantly serve low-socioeconomic populations with high proportions of smokers eligible for lung cancer screening, face significant economic and resource challenges to implementing lung cancer screening. Although these vulnerable patients are at increased risk for lung cancer, reducing patient financial burdens and appropriately managing abnormal findings are critical to ensure that offering screening does not inadvertently lead to harm and increase disparities.

Early Detection of Cancer - methods

Safety-net Providers - statistics & numerical data

Humans

Middle Aged

Smokers - statistics & numerical data

Ambulatory Care Facilities - economics

Physician Executives - statistics & numerical data

Mass Screening - methods

Tobacco Use - adverse effects

Socioeconomic Factors

Health Resources - statistics & numerical data

Mass Screening - legislation & jurisprudence

Lung Neoplasms - etiology

Vulnerable Populations - statistics & numerical data

Poverty - statistics & numerical data

Early Detection of Cancer - economics

Health Plan Implementation - statistics & numerical data

Healthcare Disparities - statistics & numerical data

Ambulatory Care Facilities - statistics & numerical data

Safety-net Providers - economics

Mass Screening - economics

Health Expenditures - statistics & numerical data

Health Plan Implementation - economics

Mass Screening - organization & administration

Tobacco Use - epidemiology

Safety-net Providers - organization & administration

Healthcare Disparities - economics

Aged

Lung Neoplasms - diagnosis

Health Care Surveys - statistics & numerical data

Details

Title: Subtitle: Challenges Implementing Lung Cancer Screening in Federally Qualified Health Centers
Creators: Steven B Zeliadt - Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Health Administration, Seattle, Washington. Electronic address: szeliadt@uw.edu
Richard M Hoffman - Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa; Holden Comprehensive Cancer Center, Iowa City, Iowa
Genevieve Birkby - Center for Community Health Integration and the Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, Ohio
Jan M Eberth - Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
Alison T Brenner - Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
Daniel S Reuland - Department of Medicine, Division of General Internal Medicine, University of North Carolina, Chapel Hill, North Carolina
Susan A Flocke - Center for Community Health Integration and the Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, Ohio; Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio; Cancer Prevention, Control and Population Research, Case Comprehensive Cancer Center, Cleveland, Ohio
Resource Type: Journal article
Publication Details: American journal of preventive medicine, Vol.54(4), pp.568-575
DOI: 10.1016/j.amepre.2018.01.001
PMID: 29429606
PMCID: PMC8483158
NLM abbreviation: Am J Prev Med
ISSN: 0749-3797
eISSN: 1873-2607
Grant note: P30 CA086862 / NCI NIH HHS
Language: English
Date published: 04/2018
Academic Unit: Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984094548802771

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