UCLA

Lung cancer is the leading cause of cancer-related death. Lung cancer screening (LCS), with an annual computed tomography (CT) scan for at-risk smokers, can save lives by diagnosing and treating cancer early. Yet lung cancer screening rates have unfortunately been woefully low to date, with additional racial/ethnic disparities in screening rates. Centralization, or the use of dedicated lung cancer screening staff and electronic medical record infrastructure for tracking screening, is a promising intervention that in small trials has been associated with increasing lung cancer screening rates potentially by unburdening the primary care physicians who typically would be responsible for screening their patients. This dissertation investigated the association of lung cancer screening program centralization on lung cancer screening rates through descriptive analysis and retrospective, mixed methods analysis of Veterans Health Administration electronic medical record data and program surveys on centralization status. In a descriptive analysis of our dataset, we found that a significant proportion of veterans are eligible for lung cancer screening, with greater than 1 million veterans meeting current eligibility criteria. We found that centralization was associated with increased likelihood of receiving appropriate and timely follow up after initial screening. Furthermore, our analysis suggests that hybrid centralized programs, where primary care physicians (PCPs) co-manage screening with lung cancer screening centralized staff, were associated with the highest odds of receiving appropriate and timely follow up. In a subset of Black and White Veterans, our findings suggest hybrid centralized programs were associated with higher odds of Black Veterans entering screening. However, centralization was not associated with improved Black/White disparities in receiving appropriate and timely follow up. We postulate hybrid programs may be best matching PCP-patient rapport and trust with support for overburdened PCPs through centralized staff. Understanding the results of the current study can provide valuable insights for healthcare systems and policy makers by highlighting the most effective screening strategies, addressing ongoing racial disparities. and informing the design of program interventions that can further optimize screening rates while supporting health providers and patients.