PrOVE QUERI Project #1

Completed

Interventions: Other: Webinar, Promotion, and Tool Access
Other: LEAP
Other: Audit and Feedback
Other: Academic Detailing

Brief Summary: The overall goal of this project is to test two strategies for implementing a shared decision making tool to be used by providers while talking to patients about lung cancer screening. Eight participating sites will be randomized to compare standard implementation with intensive implementation. Additionally, the investigators will determine the factors that were most important for successful implementation of the shared decision making tool. Finally, the investigators will survey patients to evaluate the effects of Decision Precision on patient's knowledge of the risks and benefits of lung cancer screening, the quality of their decision making, and their satisfaction with care.

Detailed Description: The overall goal of this quality improvement project is to test two strategies for implementing shared decision making, which incorporates the Decision Precision lung cancer screening tool. The investigators will use multi-site, cluster-based randomization to compare standard implementation with intensive implementation. Additionally, the investigators will determine the factors that were most important for successful implementation of the shared decision making tool. Finally, the investigators will have a human subjects research component to evaluate the effects of Decision Precision on patient's knowledge of the risks and benefits of lung cancer screening, the quality of their decision making, and their satisfaction with care.

Recruitment & Eligibility

Inclusion Criteria

Patients at participating sites without documented exclusions for lung cancer screening who have had initial lung cancer screening clinical reminders resolved during the recruitment period

Exclusion Criteria

Exclusions for initial lung cancer screening clinical reminders:

history of lung, pancreatic, liver or esophageal cancer
a health factor on file indicating they have a life expectancy of less than 6 months or who already had a chest CT in the past 12 months

Arm && Interventions

Group	Intervention	Description
intensive implementation	Academic Detailing	Webinar, Promotion, and Tool Access, academic detailing + Audit and Feedback + LEAP
intensive implementation	Audit and Feedback	Webinar, Promotion, and Tool Access, academic detailing + Audit and Feedback + LEAP
intensive implementation	LEAP	Webinar, Promotion, and Tool Access, academic detailing + Audit and Feedback + LEAP
standard implementation	Webinar, Promotion, and Tool Access	Webinar, Promotion, Tool Access, academic detailing + Audit and Feedback
standard implementation	Audit and Feedback	Webinar, Promotion, Tool Access, academic detailing + Audit and Feedback
standard implementation	Academic Detailing	Webinar, Promotion, Tool Access, academic detailing + Audit and Feedback
intensive implementation	Webinar, Promotion, and Tool Access	Webinar, Promotion, and Tool Access, academic detailing + Audit and Feedback + LEAP

Primary Outcome Measures

Name	Time	Method
Odds Ratio of the Interaction Between Lung Cancer Risk and Implementation Arm	post implementation, an average of 15 months	First, we estimated screening's net benefit for an individual based on their baseline lung cancer risk, as estimated using the Bach et. al. annual lung cancer incidence model. Patients are considered "high benefit" if their annual lung cancer risk is between 0.3%-1.3%. Patients outside this range are considered "preference sensitive". We fit a multilevel logistic regression model where receipt of screening is the outcome. Precision decision making is reflected in the association between baseline lung cancer risk and screening utilization: an increase in screening utilization for those at higher lung cancer risk indicates some degree of precision decision making. The primary outcome for the cluster-randomized design assesses the difference in precision decision making in the standard vs. intensive implementation arms. This is estimated as the effect on screening receipt of the interaction between risk and implementation arm.
Patient Satisfaction With Decision and Process	Survey mailed to Veteran several weeks after identified as having an initial discussion about lung cancer screening using VA administrative data	Obtained from patient surveys (for the subset of the overall participants who returned surveys). The unit of measurement is one unit on the scale \[scale of 0 (very poor) to 10 (very good)\].

Secondary Outcome Measures

Name	Time	Method
Number of Tool Assessments Where Patient Decision Aid Was Printed	post implementation, up to 25 months	Number of times during study duration where patient decision aid was printed from the Lung Decision Precision web-site.
Number of Times Dynamic Pictograph Depicting Personalized Benefit and Harm Was Opened for Display	post implementation, up to 25 months	Number of times dynamic pictograph depicting personalized benefit and harm was opened for display in the Lung Decision Precision web-site during the study period, collected as para data from Decision Precision web-site
Formative Evaluation to Determine the Factors Most Important for Successful Implementation of Decision Precision Tool	At least one year post-implementation of Lung Decision Precision web-site	Qualitative analysts will conduct telephone interviews with providers at each site who identify themselves as participating in shared decision making process with patients regarding lung cancer screening. Reporting for this report is number of interviews completed of number interviews requested.

Locations (8): VA Ann Arbor Healthcare System, Ann Arbor, MI
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Ann Arbor, Michigan, United States
Minneapolis VA Health Care System, Minneapolis, MN
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Minneapolis, Minnesota, United States
Manhattan Campus of the VA NY Harbor Healthcare System, New York, NY
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New York, New York, United States
Durham VA Medical Center, Durham, NC
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Durham, North Carolina, United States
Cincinnati VA Medical Center, Cincinnati, OH
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Cincinnati, Ohio, United States
VA Portland Health Care System, Portland, OR
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Portland, Oregon, United States
Providence VA Medical Center, Providence, RI
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Providence, Rhode Island, United States
Ralph H. Johnson VA Medical Center, Charleston, SC
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Charleston, South Carolina, United States