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, Sue Flocke

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction: 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. Methods: 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. Results: 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%). Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)568-575
Number of pages8
JournalAmerican journal of preventive medicine
Volume54
Issue number4
DOIs
StatePublished - Apr 1 2018
Externally publishedYes

Fingerprint

Early Detection of Cancer
Lung Neoplasms
Health
Physician Executives
Tobacco Use
Safety-net Providers
Community Health Centers
Health Expenditures
Insurance
Economics
Population
Surveys and Questionnaires

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

Challenges Implementing Lung Cancer Screening in Federally Qualified Health Centers. / Zeliadt, Steven B.; Hoffman, Richard M.; Birkby, Genevieve; Eberth, Jan M.; Brenner, Alison T.; Reuland, Daniel S.; Flocke, Sue.

In: American journal of preventive medicine, Vol. 54, No. 4, 01.04.2018, p. 568-575.

Research output: Contribution to journalArticle

Zeliadt, Steven B. ; Hoffman, Richard M. ; Birkby, Genevieve ; Eberth, Jan M. ; Brenner, Alison T. ; Reuland, Daniel S. ; Flocke, Sue. / Challenges Implementing Lung Cancer Screening in Federally Qualified Health Centers. In: American journal of preventive medicine. 2018 ; Vol. 54, No. 4. pp. 568-575.
@article{519defffdc5e4e89b6e7e4f6a61c66e9,
title = "Challenges Implementing Lung Cancer Screening in Federally Qualified Health Centers",
abstract = "Introduction: 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. Methods: 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. Results: 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{\%}). Conclusions: 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.",
author = "Zeliadt, {Steven B.} and Hoffman, {Richard M.} and Genevieve Birkby and Eberth, {Jan M.} and Brenner, {Alison T.} and Reuland, {Daniel S.} and Sue Flocke",
year = "2018",
month = "4",
day = "1",
doi = "10.1016/j.amepre.2018.01.001",
language = "English (US)",
volume = "54",
pages = "568--575",
journal = "American Journal of Preventive Medicine",
issn = "0749-3797",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Challenges Implementing Lung Cancer Screening in Federally Qualified Health Centers

AU - Zeliadt, Steven B.

AU - Hoffman, Richard M.

AU - Birkby, Genevieve

AU - Eberth, Jan M.

AU - Brenner, Alison T.

AU - Reuland, Daniel S.

AU - Flocke, Sue

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Introduction: 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. Methods: 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. Results: 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%). Conclusions: 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.

AB - Introduction: 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. Methods: 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. Results: 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%). Conclusions: 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.

UR - http://www.scopus.com/inward/record.url?scp=85041678779&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041678779&partnerID=8YFLogxK

U2 - 10.1016/j.amepre.2018.01.001

DO - 10.1016/j.amepre.2018.01.001

M3 - Article

VL - 54

SP - 568

EP - 575

JO - American Journal of Preventive Medicine

JF - American Journal of Preventive Medicine

SN - 0749-3797

IS - 4

ER -