Protocol to evaluate an enterprise-wide initiative to increase access to lung cancer screening in the Veterans Health Administration

• Authors: Jennifer A Lewis, VA Tennessee Valley Healthcare System; Lucy B Spalluto, VA Tennessee Valley Healthcare System; Claudia Henschke, Icahn School of Medicine at Mount Sinai; David F Yankelevitz, Icahn School of Medicine at Mount Sinai; Samuel M Aguayo, Phoenix VA Health Care System; Providencia Morales, Phoenix VA Health Care System; Rick Avila, Paraxial LLC; Carolyn M Audet, Vanderbilt University; Beth Prusaczyk, Washington University School of Medicine; Christopher J Lindsell, Vanderbilt University; Carol Callaway-Lane, VA Tennessee Valley Healthcare System; Robert S Dittus, VA Tennessee Valley Healthcare System; Timothy J Vogus, Vanderbilt University; Pierre P Massion, Vanderbilt Ingram Cancer Center; Heather M Limper, Vanderbilt University; Sunil Kripalani, Vanderbilt University; Drew Moghanaki, Emory University; Christianne L Roumie, VA Tennessee Valley Healthcare System
• Journal Title: CLINICAL IMAGING
• Volume: Volume 73
• Publisher: ELSEVIER SCIENCE INC | 2021-01-07, Pages 151-161
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.clinimag.2020.11.059
• Subjects: Health Sciences, Oncology; Health Sciences, Medicine and Surgery; Biology, Biostatistics
• Keywords: Science & Technology; Life Sciences & Biomedicine; Radiology, Nuclear Medicine & Medical Imaging; Lung cancer screening; Program evaluation; Veterans; Implementation science

Abstract

Introduction: The Veterans Affairs Partnership to increase Access to Lung Screening (VA-PALS) is an enterprise-wide initiative to implement lung cancer screening programs at VA medical centers (VAMCs). VA-PALS will be using implementation strategies that include program navigators to coordinate screening activities, trainings for navigators and radiologists, an open-source software management system, tools to standardize low-dose computed tomography image quality, and access to a support network. VAMCs can utilize strategies according to their local needs. In this protocol, we describe the planned program evaluation for the initial 10 VAMCs participating in VA-PALS. Materials and methods: The implementation of programs will be evaluated using the Consolidated Framework for Implementation Research to ensure broad contextual guidance. Program evaluation measures have been developed using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Adaptations of screening processes will be assessed using the Framework for Reporting Adaptations and Modifications to Evidence Based Interventions. Measures collected will reflect the inner settings, estimate and describe the population reached, adoption by providers, implementation of the programs, report clinical outcomes and maintenance of programs. Analyses will include descriptive statistics and regression to evaluate predictors and assess implementation over time. Discussion: This theory-based protocol will evaluate the implementation of lung cancer screening programs across the Veterans Health Administration using scientific frameworks. The findings will inform plans to expand the VA-PALS initiative beyond the original sites and can guide implementation of lung cancer screening programs more broadly.