组织准备度与肺癌筛查利用的关联。
The Association of Organizational Readiness With Lung Cancer Screening Utilization.
机构信息
VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Medical Service, VA Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, Tennessee; Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
出版信息
Am J Prev Med. 2023 Nov;65(5):844-853. doi: 10.1016/j.amepre.2023.05.018. Epub 2023 May 22.
INTRODUCTION
Lung cancer screening is widely underutilized. Organizational factors, such as readiness for change and belief in the value of change (change valence), may contribute to underutilization. The aim of this study was to evaluate the association between healthcare organizations' preparedness and lung cancer screening utilization.
METHODS
Investigators cross-sectionally surveyed clinicians, staff, and leaders at10 Veterans Affairs from November 2018 to February 2021 to assess organizational readiness to implement change. In 2022, investigators used simple and multivariable linear regression to evaluate the associations between facility-level organizational readiness to implement change and change valence with lung cancer screening utilization. Organizational readiness to implement change and change valence were calculated from individual surveys. The primary outcome was the proportion of eligible Veterans screened using low-dose computed tomography. Secondary analyses assessed scores by healthcare role.
RESULTS
The overall response rate was 27.4% (n=1,049), with 956 complete surveys analyzed: median age of 49 years, 70.3% female, 67.6% White, 34.6% clinicians, 61.1% staff, and 4.3% leaders. For each 1-point increase in median organizational readiness to implement change and change valence, there was an associated 8.4-percentage point (95% CI=0.2, 16.6) and a 6.3-percentage point increase in utilization (95% CI= -3.9, 16.5), respectively. Higher clinician and staff median scores were associated with increased utilization, whereas leader scores were associated with decreased utilization after adjusting for other roles.
CONCLUSIONS
Healthcare organizations with higher readiness and change valence utilized more lung cancer screening. These results are hypothesis generating. Future interventions to increase organizations' preparedness, especially among clinicians and staff, may increase lung cancer screening utilization.
简介
肺癌筛查的利用率普遍较低。组织因素，如对变革的准备和对变革价值的信念（变革效价），可能是利用率低的原因之一。本研究旨在评估医疗机构准备程度与肺癌筛查利用之间的关系。
方法
研究人员于 2018 年 11 月至 2021 年 2 月在 10 家退伍军人事务部对临床医生、工作人员和领导进行了横断面调查，以评估实施变革的组织准备情况。在 2022 年，研究人员使用简单和多变量线性回归来评估设施级别的组织准备实施变革和变革效价与肺癌筛查利用之间的关联。组织准备实施变革和变革效价是从个人调查中计算出来的。主要结果是使用低剂量计算机断层扫描筛查合格退伍军人的比例。次要分析评估了按医疗保健角色划分的分数。
结果
总体回复率为 27.4%（n=1,049），有 956 份完整的调查进行了分析：中位年龄为 49 岁，70.3%为女性，67.6%为白人，34.6%为临床医生，61.1%为工作人员，4.3%为领导。组织准备实施变革和变革效价的中位数每增加 1 分，与利用率增加 8.4 个百分点（95%CI=0.2，16.6）和 6.3 个百分点相关（95%CI=-3.9，16.5）。调整其他角色后，较高的临床医生和工作人员的中位数分数与利用率增加相关，而领导分数与利用率降低相关。
结论
准备程度和变革效价较高的医疗机构使用了更多的肺癌筛查。这些结果只是初步的。未来干预措施提高组织准备度，尤其是提高临床医生和工作人员的准备度，可能会增加肺癌筛查的利用率。
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