Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX; Division of Hematology-Oncology, UT Southwestern Medical Center, Dallas, TX; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX.
Departments of Psychology and Family and Community Medicine, University of Arizona, Tucson, AZ.
Clin Lung Cancer. 2021 Jul;22(4):e612-e620. doi: 10.1016/j.cllc.2020.12.001. Epub 2020 Dec 11.
Less than 5% of eligible individuals in the United States undergo lung cancer screening. Variation in clinicians' participation in lung cancer screening has not been determined.
We studied medical providers who ordered ≥ 1 low-dose computed tomography (LDCT) for lung cancer screening from February 2017 through February 2019 in an integrated safety-net healthcare system. We analyzed associations between provider characteristics and LDCT orders and completion using chi-square, Fisher exact, and Student t tests, as well as ANOVA and multinomial logistic regression.
Among an estimated 194 adult primary care physicians, 144 (74%) ordered at least 1 LDCT, as did 39 specialists. These 183 medical providers ordered 1594 LDCT (median, 4; interquartile range, 2-9). In univariate and multivariate models, family practice providers (P < .001) and providers aged ≥ 50 years (P = .03) ordered more LDCT than did other clinicians. Across providers, the median proportion of ordered LDCT that were completed was 67%. The total or preceding number of LDCT ordered by a clinician was not associated with the likelihood of LDCT completion.
In an integrated safety-net healthcare system, most adult primary care providers order LDCT. The number of LDCT ordered varies widely among clinicians, and a substantial proportion of ordered LDCT are not completed.
在美国，只有不到 5%的符合条件的个人接受肺癌筛查。临床医生参与肺癌筛查的情况存在差异。
我们研究了在一个综合性的安全网医疗体系中，在 2017 年 2 月至 2019 年 2 月期间，至少为 1 名患者开出≥1 次低剂量计算机断层扫描（LDCT）肺癌筛查的医疗服务提供者。我们使用卡方检验、Fisher 确切检验、学生 t 检验以及方差分析和多项逻辑回归分析，分析了提供者特征与 LDCT 订单和完成之间的关联。
在估计的 194 名成年初级保健医生中，有 144 名（74%）至少开出了 1 次 LDCT，39 名专家也开出了 1 次 LDCT。这 183 名医疗服务提供者共开出了 1594 次 LDCT（中位数为 4 次；四分位间距为 2-9 次）。在单变量和多变量模型中，家庭执业医生（P<.001）和≥50 岁的医生（P=.03）开出的 LDCT 比其他医生更多。在所有医生中，已开 LDCT 中完成比例的中位数为 67%。医生开出的 LDCT 总数或前序数量与 LDCT 完成的可能性无关。
在一个综合性的安全网医疗体系中，大多数成年初级保健医生会开出 LDCT。临床医生开出的 LDCT 数量差异很大，而且很大一部分开出的 LDCT 并未完成。
