B80-4-12 Variation in Processes for Incidental Pulmonary Nodule Management Across the Veterans Health Administration

Rationale Incidental Pulmonary Nodules (IPN) are increasingly identified but often lost to follow up. Although structured IPN programs improve early lung cancer detection, it is unknown what resources and processes are available for managing IPNs within the VA health care system. Methods We conducted a cross-sectional survey of medical centers from the VA Lung Precision Oncology Program (LPOP). Survey content was based on literature review of evidence-based processes for IPN management and discussions with members of the LPOP Lung Cancer Screening Outcomes Workgroup. This work group included several thought leaders in lung cancer screening and nodule management. The survey was created in Redcap and distributed electronically to the LPOP network to be completed by one representative from each medical center. A total of 42 sites initiated the survey, and 26 submitted complete responses. Results Among participating VA medical centers in LPOP, the majority were high complexity facilities (76.9%) and Commission on Cancer (CoC) accredited (61.5%). The pulmonary department was most commonly in charge of tracking and managing IPNs (57.7%). Use of systems to support IPN tracking and management were wide-ranging (Figure 1). Various clinical processes were used including: radiology flags ordering provider (53.9%), flags to another clinician (65.4%), tracking registries (50%), dedicated nodule clinics (50%), structured operating procedures (23.1%), Electronic Medical Record (EMR)- linked decision support tools (19.2%), pulmonary review with radiology for all new nodules (19.2%), and tracking or feedback regarding radiology coding or description of IPNs (11.5%). When asked about preferred resources to support IPN management, respondents perceived usefulness of a nationally available patient tracker (73.1%), reports or dashboard for new IPNs (84.6%), VA-specific guidance on applying Fleischner guidelines (69.2%) and a toolkit for improving quality of IPN management (69.2%). Conclusions There are substantial variations in IPN management across VA medical centers despite the perceived usefulness of centralized processes. Variation in IPN management across VA medical centers underscores the need for standardized processes to support early lung cancer detection. This abstract is funded by: Lilly Foundation, grant number A-38710