Program Structure
The structure of each LCS program will depend on available resources, the type of institution and practice, and the skills and interests of the individual providers. Often new LCS programs will build upon or arise from pre-existing multidisciplinary lung cancer clinics and/ or tumor boards. Most LCS programs fit within one of three general categories.
At one end, a centralized LCS program actively recruits eligible patients, conducts education and shared decision-making visits, assists in smoking cessation, and schedules, orders, performs, and interprets all screening studies. The program also arranges consultations, schedules follow-up studies, and tracks all clinical and outcome data. The centralized LCS program communicates results and plans to the patient and referring provider. This model requires significant resources including a dedicated LCS coordinator, clinical leadership, and an integrated multidisciplinary program team.
At the other end, a decentralized LCS program performs the LCS exam and interpretation and leaves the referring provider responsible for all other functions.
In between the extremes of a completely centralized and a completely decentralized program are many examples of hybrid LCS programs with some centralized processes and other aspects decentralized, i.e., deferred to the primary care provider.
Participating LCS Center Profiles and Panelists
Institution/Panel Member |
Brief description of organization and LCS program |
Describe program structure: |
What is your program governance structure? |
Type of tracking system |
Unique populations served by program |
|---|---|---|---|---|---|
Boston Medical Center Renda Soylemez Wiener (RSW) Katrina Steiling (KS) |
Boston Medical Center is an academically affiliated urban tertiary care center and the largest safety-net hospital in New England |
Hybrid program: Decentralized ordering/ centralized tracking |
Mutlidisciplinary steering committee Pulmonary and Radiology |
Database for registry /tracking |
Minority, inner city poor |
Christiana Care Health System Albert Rizzo (AR) |
Christiana Care Health System, headquartered in Wilmington, Delaware, is one of the country’s largest health care community teaching hospitals |
Centralized: SDM and orders performed by dedicated LCS program personnel |
Pulmonary/ Thoracic Surgery Pulmonary with close partnership with Radiology |
In-house developed tool |
Minority representation We participate in the state’s Screening for Life Program for the uninsured |
Cleveland Clinic Peter Mazzone (PM) |
The Cleveland Clinic health system is an academic multi- specialty group practice |
Centralized: SDM and orders performed by dedicated LCS program personnel |
Pulmonary Pulmonary with close partnership with Radiology |
Internal registries implementing a purchased patient management software package |
N/A |
Kaiser Permanente Southern California Michael Gould (MKG) |
Kaiser Permanente Southern California (KPSC) is a fully integrated health care system that provides comprehensive care to over 4.4 million members at 14 hospitals and over 200 medical offices in the southern California region | Decentralized: SDM and orders by PCP with limited centralized verification, scheduling or tracking |
Radiology Pulmonary Primary Care input |
We have a robust infrastructure at regional headquarters and individual medical centers to support data analytics and tracking |
Minority representation The KPSC membership reflects the diversity of the source population in southern California, with large numbers of Hispanics (>30%) and African Americans (11%) |
Lahey Hospital and Medical Center Andrea Mckee (AM) Andrea Borondy Kitts (ABK) Brady McKee (BM) Carla Lamb (CL) Shawn Regis (SR) |
Lahey Hospital & Medical Center is an academically affiliated multispecialty group practice accountable care organization |
Hybrid program Decentralized ordering/ centralized tracking |
Multidisciplinary steering committee Radiology Radiation Oncology |
Commercially available LCS patient tracking database |
|
Mount Auburn Hospital Carey Conley Thomson (CCT) Kaitlyn Kelley (KK) |
Mount Auburn Hospital is a community based academic center associated with Harvard Medical School and a part of a long-standing accountable care organization |
Hybrid program Decentralized ordering/ centralized tracking |
Centralized governance Radiology Pulmonary |
EMR-based registry and manually entered databases |
Minority representation We are located in Cambridge, MA and serve immigrant populations of a number of countries as well as an African-American and homeless population |
Mount Sinai Health System Charles A Powell (CAP) Andrea Wolf (AW) |
Mount Sinai Health System includes seven teaching hospitals and the Icahn School of Medicine at Mount Sinai. It is an Accountable Care Organization (ACO) |
Centralized: SDM and orders performed by dedicated LCS program personnel |
Radiology |
As of 2000, we use the I-ELCAP database which we developed to capture background data, and CT information and images |
African-American, Hispanic, and other minority and immigrant populations |
Northwestern Medicine Eric M Hart (EMH) |
Northwestern Medicine (NM) is an integrated healthcare system anchored by our downtown Chicago academic hub providing primary-quaternary medical care throughout Chicago and its northern and western suburbs through our network of regional medical groups and facilities. NM consists of a multispecialty academic hub and multiple regional community practices |
Hybrid program: Decentralized ordering/centralized tracking The exact structure varies slightly by region |
We have multidisciplinary steering committees in each region that cooperate on overall strategy Radiology Other: The clinical LCS program is managed in radiology in the central and north regions, and in oncology in the west region |
Patient and outcomes tracking are regionally supported by tools developed within the institution |
With its regional presence, NM serves a broad spectrum of Chicagoland patients, from urban to suburban to exurban |
New York University - Langone Health Gaetane Michaud (GM) |
New York University Langone Health is a health network consisting of 5 hospitals, Tisch (academic private hospital), Bellevue Hospital (public city hospital), NYU Brooklyn (large community hospital in Brooklyn), Winthrop (large community hospital on Long Island) and Manhattan VA. Screening is currently only being offered at Tisch, however there are plans to expand the program to both NYU Brooklyn and Winthrop Hospital over the next 6-12 months |
Pulmonary We have a steering committee consisting of thoracic radiologists (3), thoracic surgery (2), Medical IT (1), Pulmonology (5) |
We have a commercially available database |
Minority representation |
|
The Ohio State University Derrick Herman (DH) Edwin Jackson (EJ) |
The Ohio State University is a tertiary care center with two screening sites
The first is the State University Wexner Medical Center and the second is in our community outreach hospital on the East side of Columbus (UHE) |
Hybrid program: Decentralized ordering/ centralized tracking and Centralized: SDM and orders performed by dedicated LCS program personnel |
Pulmonary Pulmonary Medicine, Thoracic Radiology and Medical Oncology establish policies and procedures. Continuous monitoring of their proper implementation is done by a multidisciplinary group (Oncology, Thoracic Surgery, Interventional Radiology, Radiation Oncology and Hospital Administration) lead by Pulmonary Medicine |
EMR-based registry |
Minority representation 65% of patients screened at UHE are recipients of Ohio Medicaid and 40 percent are African-American. Operations at each clinic are identical |
PrimaCARE PC Carolyn Fruci (CF) |
PrimaCARE PC is a large, ~150 physician, multi-specialty group practice in Fall River, MA. We are affiliated with but not owned by a local community hospital |
Hybrid program: Decentralized ordering/ Centralized tracking | Multidisciplinary steering committee Pulmonary |
Manually tracked by our program coordinator |
Large percent from Portugal, Azores |
Rush University Medical Center James Mulshine (GM) |
Rush University Medical Center is an academic medical center, affiliated with Rush University. It is a not-for-profit healthcare education, and research enterprise comprising of Rush University Medical Center, Rush University, Rush Oak Park Hospital, Rush Health, and Rush Copley Hospital |
Hybrid program: Decentralized ordering/ Centralized tracking | Radiology Medical Oncology Shared-governance |
EMR-based registry, the ACR registry, and self-made commercially available non–dedicated spreadsheet |
Military Minority representation 4% of our patient population is African American 1% is of Asian descent 7% of our patient population is of unknown ethnicity |
UC Davis Health David T Cooke (DTC) |
UC Davis Health is an academic health system that is part of the University of California, Davis (UC Davis) |
Hybrid program: Decentralized ordering/ Centralized tracking |
Multidisciplinary team Led by Radiology |
EMR-based registry, ACR Registry |
Rural Minority representation Multiple minority populations |
Seattle Cancer Care Alliance/ University of Washington Medical Center David K Madtes (DKM) |
The Seattle Cancer Care Alliance /University of Washington Medical Center is a multidisciplinary group practice accountable care organization |
Hybrid program: Decentralized orders/SDM Centralized: tracking and smoking cessation performed by dedicated LCS personnel |
Radiology Pulmonary Multidisciplinary LCS Oversight Committee |
Commercially available LCS software |
Minority representation Socio-economically disadvantaged patients |
VA Portland Health Care System Christopher G Slatore (CGS) Mark Deffebach (M.D.) |
VA Portland Health Care System; Level 1A VA facility in the Pacific Northwest |
Centralized: SDM and orders performed by dedicated LCS program personnel |
Pulmonary |
EMR-based registry |
Rural Military Minority representation |
Vanderbilt University Medical Center Kim L Sandler (KLS) |
Vanderbilt University Medical Center is an academic institution providing multidisciplinary care in Nashville, TN |
Centralized: SDM and orders performed by dedicated LCS program personnel |
Radiology |
Minority representation |
Panelists are identified by their initials, so that their specific comments can be tracked in the Question and Answer portions of the following sections.
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Participating LCS Center Profiles and Panelists