Overuse of Hematocrit Testing After Elective General Surgery at a Veterans Affairs Medical Center

Background: At-risk rural veterans have low rates of lung cancer screening (LCS). This proof-of-principle quality improvement project aimed to determine whether a telehealth intervention would increase referrals for at-risk veterans living in the rural upper Midwest and attending a smoking cessation program to LCS with low-dose computed tomography (LDCT) of the chest. Methods: Sixty-eight of 74 LCS-eligible rural veterans who self-enrolled in a smoking cessation program were contacted by telephone. Those who agreed to enroll in LCS were referred to LDCT and followed for 4 months. At the conclusion of the intervention, the number of referrals and screenings performed were tabulated. LDCT reports were reviewed and scored according to Lung CT Screening Reporting and Data System (Lung-RADS) version 1.1. Results: Only 3 of 74 LCS-eligible veterans (4%) underwent LDCT before initiation of this telehealth intervention. By the conclusion of this 4-month project, 19 of 74 veterans (26%) underwent LDCT. Forty-one veterans were successfully contacted and 29 agreed to participate in LCS. Of those who agreed to participate, 19 underwent LDCT within 4 months. Of the veterans who received LDCT, 10 were diagnosed with Lung-RADS 1, 7 with Lung-RADS 2, 1 with Lung-RADS 3, and 1 with Lung-RADS 4B. Annual follow-up LDCT or referral for further evaluation were pursued in each case. Conclusions: Collectively, these data suggest that telehealth intervention could increase referrals of at-risk rural veterans to a centralized LCS program at a regional US Department of Veterans Affairs medical facility.