Centralized Program Research Articles

Impact of Multi-Component Outreach on Colorectal Cancer Screening and Genetic Testing Preferences

Background: Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide, with early detection through screening significantly reducing mortality rates. However, disparities in access to screening persist, particularly in disadvantaged communities. Fecal Immunochemical Testing (FIT) offers a cost-effective, non-invasive method that increases screening participation by eliminating the need for in-person visits. Multicomponent outreach strategies are crucial to improving participation rates, particularly in populations with limited healthcare access. Methods: This study employed a mixed-method, sequential explanatory design to assess the impact of a population-based, centralized outreach program on CRC screening rates. Quantitative data from Kaiser Permanente Northern California's (KPNC) screening program were analyzed alongside qualitative ethnographic data to explore the implementation of the FIT-based outreach system. A cohort of individuals aged 51 to 75 years was included, with screening completion rates and follow-up processes examined. Results: Among the community initially screened, 40% participated in CRC screening before intervention. The implementation of a centralized, computerized outreach system led to a significant increase in participation, with screening rates rising by 30 percentage points within eight weeks. A combination of automated phone calls, text messages, and reminders during clinic visits further increased coverage by 12 percentage points, resulting in a total screening participation rate of 80%. The study also found that mailed FIT kits significantly improved participation rates, with FIT mailers leading to a 28-percentage point increase in screening compared to opportunistic testing. Various forms of patient guidance resulted in a 17-percentage point rise in screening, while recall interventions led to a modest 3-percentage point increase. Conclusion: The study demonstrates the effectiveness of a multicomponent, centralized outreach approach in increasing CRC screening participation in a large and diverse population.

Using Telehealth to Increase Lung Cancer Screening Referrals for At-Risk Veterans in Rural Communities.

At-risk rural veterans have low rates of lung cancer screening (LCS). This proof-of-principle quality improvement project aimed to determine whether a telehealth intervention would increase referrals for at-risk veterans living in the rural upper Midwest and attending a smoking cessation program to LCS with low-dose computed tomography (LDCT) of the chest. Sixty-eight of 74 LCS-eligible rural veterans who self-enrolled in a smoking cessation program were contacted by telephone. Those who agreed to enroll in LCS were referred to LDCT and followed for 4 months. At the conclusion of the intervention, the number of referrals and screenings performed were tabulated. LDCT reports were reviewed and scored according to Lung CT Screening Reporting and Data System (Lung-RADS) version 1.1. Only 3 of 74 LCS-eligible veterans (4%) underwent LDCT before initiation of this telehealth intervention. By the conclusion of this 4-month project, 19 of 74 veterans (26%) underwent LDCT. Forty-one veterans were successfully contacted and 29 agreed to participate in LCS. Of those who agreed to participate, 19 underwent LDCT within 4 months. Of the veterans who received LDCT, 10 were diagnosed with Lung-RADS 1, 7 with Lung-RADS 2, 1 with Lung-RADS 3, and 1 with Lung-RADS 4B. Annual follow-up LDCT or referral for further evaluation were pursued in each case. Collectively, these data suggest that telehealth intervention could increase referrals of at-risk rural veterans to a centralized LCS program at a regional US Department of Veterans Affairs medical facility.

Distributed service function chaining in NFV-enabled networks: A game-theoretic learning approach

In network function virtualization (NFV), Service Function Chaining (SFC) provides an ordered sequence of virtual network functions (VNFs) and subsequent steering of traffic flows through them to cater to end-to-end services. This paper addresses the NP-hard problem of minimum cost SFC deployment to support customer services that access the carrier network’s NFV infrastructure (NFVI) through some edge routers. To determine the mappings of VNFs to physical servers, a challenging aspect would be the inter-server latencies that may fluctuate over time because of the sharing nature of cloud data centers. To construct the SFC, we come up with three different formulations, each corresponding to a different informational assumption about the link latencies: First, a centralized integer linear programming (ILP) formulation is given under the assumption of the non-causal availability of exact and instantaneous inter-server latencies. The solution to this ILP can serve as a lower bound to benchmark more scalable and realistic schemes. Next, we give a distributed game-theoretic formulation (with service broker agents as players) which only requires the statistical knowledge of link latency fluctuations. The game provably admits a pure Nash equilibrium (NE) and can be solved iteratively through the well-known best response dynamics (BRD) algorithm. Our main novelty lies in the third formulation in which each service broker has neither instantaneous nor statistical knowledge of the latencies. Instead, it relies on a game-theoretic learning algorithm to compose its VNF chain only based on its own history of adopted decisions and experienced delays on each logical link. We prove that the proposed learning algorithm asymptotically converges to NE and evaluate its performance through simulations in terms of convergence and the impact of network parameters.

Characteristics associated with early vs. late adoption of lung cancer screening

BackgroundAlthough lung cancer screening (LCS) reduces lung cancer mortality among high-risk individuals, uptake overall remains low. With all cancer screening modalities, a period of diffusion among medical providers and the public is expected, with screening uptake exhibiting a distribution among early vs. late adoption. We aimed to characterize individuals undergoing LCS based upon the timeframe of screening adoption. MethodsThis retrospective study examined patients who underwent LCS between January 2015 – December 2022 in a centralized LCS program. Based on United States Preventive Services Task Force (USPSTF) criteria for LCS, early and late adopters of LCS – defined by time from eligibility to screening completion – were compared. A multivariable regression model was constructed to identify factors associated with early adoption of LCS. ResultsAmong patients screened during the study period, 90.4% were eligible based on USPSTF 2013 criteria, and 9.6% were eligible based on USPSTF 2021 criteria. Of the USPSTF 2013 eligible persons, multivariable analysis demonstrated Black/African-American individuals and current smokers had significantly greater odds of early adoption (aOR 1.428 and 1.514, respectively). Those without a family history of lung cancer or without a personal history of cancer had significantly lower odds of early adoption of LCS. ConclusionsEarly adopters were more likely to report Black/African-American race or current smoking status after adjustment for covariates. Future research should examine how screening diffuses across the overall LCS-eligible population, as well as identify factors that drive and inhibit diffusion to create programs and policies with the ultimate goal of increasing timely LCS uptake.

Reducing costs and improving patient recovery through a nurse-driven centralized spinal orthoses program on a post-surgical unit: A quality improvement initiative

BackgroundAn external vendor providing off-the-shelf spinal orthoses to inpatients created significant costs and barriers to quality care for spinal surgery patients. A nursing leadership team initiated a quality improvement project to reduce the cost of providing off-the-shelf spinal orthoses and improve the care provided to spinal patients. ObjectiveTo develop and evaluate a nursing-led process for providing off-the-shelf orthoses to spinal surgery patients and eliminate high costs. DesignQuality improvement project evaluated as a retrospective interrupted time-series SettingPost Surgery Inpatient Unit Level II Trauma Center in a United States hospital located in Florida ParticipantsVendor Program: 134 patients; Centralized Program: 155 patients MethodsThe nursing leadership team developed a centralized spinal orthoses program where the bedside nurse fitted the patient with a spinal orthosis, eliminating the need for an external orthotist. The study quantifies changes in study metrics by comparing patients identified through chart review who received care in the vendor program to those who received care in the centralized program utilizing nonparametric statistical techniques. ResultsThe centralized nursing-led spinal orthosis program allowed the unit to mobilize patients more quickly than patients managed under the vendor program (3.85 hr. [95 % CI: 1.27 to 7.26 hrs] reduction; p = 0.004). The overall length of stay was reduced by 0.78 days ([1.34 – 0.02 days]; p = 0.063) or 18.72 h. While the statistical test did not indicate significance, the 18.72-hour reduction in length of stay represents a potential clinically relevant finding. Evaluating patients that suffered a primary spinal injury and no complications (vendor program: 54 patients; centralized program: 86 patients) showed a similar reduction in time to mobilization (4.5 hr reduction [0.53 to 12.93 hrs]; p = 0.025), but the length of stay reduction increased to 1.02 days [0.12 to 1.97 days], a difference determined to be statistically significant (p = 0.014). Centralizing the process for providing off-the-shelf spinal orthoses reduced the cost of a thoracic-lumbar sacral orthosis by $1,483 and the price of a lumbar-sacral orthosis by $1,327. Throughout the study, the new program reduced the cost of providing spinal orthoses by $175,319. ConclusionsThe results demonstrate that the nursing-led centralized spinal orthosis program positively impacted the quality of care provided to our patients while also reducing the cost of delivering the orthoses. Tweetable abstractA nursing-led centralized spinal orthosis program reduces the cost of care while reducing time to mobilization and length of stay.

Provision of Coaching and Mentoring Experiences: Narratives of Public Elementary School Teachers

This study narrated the lived experiences of public elementary school teachers who have undergone coaching and mentoring, shedding light on their coping strategies for addressing weaknesses and their insights into educational learning. This employed qualitative phenomenological research. Ten participants, recipients of coaching and mentoring, provided rich narratives that coalesced around three primary themes: engagement in professional development, adequacy of training resources, and the demands of the work environment. Concurrently, coping strategies for the challenges associated with coaching revealed three major themes: establishing teaching competence, demonstrating collaborative practices, and embracing reflective practices. Furthermore, the study identified two overarching learning insights derived from teachers' lived experiences: a dedication to being work-oriented and motivated. School leaders must recognize the transformative potential of coaching and mentoring in enhancing teaching practices. Teachers, in turn, should actively embrace and participate in any technical assistance provided. The Department of Education officials are urged to leverage the study's findings to develop a centralized professional development program that aligns with teachers' competencies and needs. Finally, students are encouraged to actively engage in classroom activities to foster a meaningful and holistic educational outcome.

The Outcome of A Centralization Program in Biliary atresia: 20 years and beyond.

Biliary atresia (BA) is a rare disease and reported outcomes of surgical management, typically a Kasai portoenterostomy (KPE), vary considerably across the world. Centralization has been proposed to improve this. A national centralization programme was started in Jan. 1999, involving 3 English units with co-located liver transplant facilities. As the program has now reached the 20-year point, the main aim was to update outcome statistics and identify trends. Prospective registry and database. The main measures of outcome were (i) time to KPE, (ii) Clearance of Jaundice (CoJ), defined as reaching a bilirubin value of <20µmol/L (≈1.5 mg/dL), and (iii) actuarial native liver survival (NLS) and overall survival (OS). Data are quoted as median (IQR) and non-parametric statistical comparison used with P<0.05 regarded as significant. 867 infants were born with BA and managed between January 1999 and December 2019. Death occurred without intervention (n=10, 1.1%) or were subject to primary transplant (n=26, 3.0%); leaving 831 (95.9%) infants who underwent KPE at median age of 51 (IQR 39-64) days. Age at KPE reduced over the period (P=0.0001) becoming 48(35-57) days in the last 5-year era. CoJ was achieved in 505/831 (60.6%), also increasing over the period (P=0.002). 42 (5.0%) died post-KPE and 384 were transplanted, leaving 405 alive with their native livers at last follow-up. Of the 412 children transplanted, there were 23 (5.6%) deaths, leaving 387 alive. 5-year and 10-year native liver survival were 51.3% (95% CI 54.8-47.8) and 46.5% (95% CI 50.1 - 42.9) and overall survival were 91.5% (95% CI 93.2 - 89.4) and 90.5% (95% CI 92.3 - 88.2%) respectively. There have been continued improvements in efficiency over the period of centralization with a significant reduction in time to KPE and improved CoJ following KPE. Overall survival in this disease remains >90%.

Development of a distributed group control strategy for pumping well groups connected by multisource DC microgrids

Due to the alternating loads on pumping units and the integration of new energy sources, multisource DC microgrid pumping unit well groups experience increased fluctuations in voltage and power as well as superimposed peak and valley values. This work presents a distributed control strategy for pumping unit well groups on a multisource DC microgrid based on the weighted moving average algorithm. A centralized control program is implanted in the RTU of the single-well controller of each pumping unit, and communication with each well is realized via SCADA and multicast communication, resulting in a distributed well group system. The real-time power values of the pumping well group are calculated by grouping the power values, and each group is weighted using the total power fluctuation threshold of the well group as the control target. Then, a weighted moving average algorithm is used to predict the next power value and form a table of predicted real-time power spectra. According to the power values in the community power spectrum table, the inverter frequency is proportionally adjusted downwards to reach the power peak before deceleration; after the power peak is crossed, the frequency is increased in the same way to reach the power valley before acceleration. Finally, the peak and valley power values of the bus system level off and further learn to reach the set impulse; ultimately, a stable impulse is formed. In laboratory testing and field application in the Shengli Oilfield XIN-11 block, the group control software module effectively suppressed the active power peak and valley values and voltage fluctuations of the bus system, the active power fluctuation rate range decreased by more than 70%, and the DC bus voltage fluctuation range decreased by more than 80%; moreover, the active power decreased by approximately 6% without additional hardware costs.

Individual- and neighborhood-level characteristics of lung cancer screening participants undergoing telemedicine shared decision making

BackgroundAlthough lung cancer screening (LCS) for high-risk individuals reduces lung cancer mortality in clinical trial settings, many questions remain about how to implement high-quality LCS in real-world programs. With the increasing use of telemedicine in healthcare, studies examining this approach in the context of LCS are urgently needed. We aimed to identify sociodemographic and other factors associated with screening completion among individuals undergoing telemedicine Shared Decision Making (SDM) for LCS.MethodsThis retrospective study examined patients who completed Shared Decision Making (SDM) via telemedicine between May 4, 2020 – March 18, 2021 in a centralized LCS program. Individuals were categorized into Complete Screening vs. Incomplete Screening subgroups based on the status of subsequent LDCT completion. A multi-level, multivariate model was constructed to identify factors associated with incomplete screening.ResultsAmong individuals undergoing telemedicine SDM during the study period, 20.6% did not complete a LDCT scan. Bivariate analysis demonstrated that Black/African-American race, Medicaid insurance status, and new patient type were associated with greater odds of incomplete screening. On multi-level, multivariate analysis, individuals who were new patients undergoing baseline LDCT or resided in a census tract with a high level of socioeconomic deprivation had significantly higher odds of incomplete screening. Individuals with a greater level of education experienced lower odds of incomplete screening.ConclusionsAmong high-risk individuals undergoing telemedicine SDM for LCS, predictors of incomplete screening included low education, high neighborhood-level deprivation, and new patient type. Future research should focus on testing implementation strategies to improve LDCT completion rates while leveraging telemedicine for high-quality LCS.

Single-Agent Reinforcement Learning for Scalable Earth-Observing Satellite Constellation Operations

This work explores single-agent reinforcement learning for the multi-satellite agile Earth-observing scheduling problem. The objective of the problem is to maximize the weighted sum of imaging targets collected and downlinked while avoiding resource constraint violations on board the spacecraft. To avoid the computational complexity associated with multi-agent deep reinforcement learning while creating a robust and scalable solution, a policy is trained in a single satellite environment. This policy is then deployed on board each satellite in a Walker-delta constellation. A global set of targets is distributed to each satellite based on target access. The satellites communicate with one another to determine whether an imaging target is imaged or downlinked. Free communication, line-of-sight communication, and no communication are explored to determine how the communication assumptions and constellation design impact performance. Free communication is shown to produce the best performance, and no communication is shown to produce the worst performance. Line-of-sight communication performance is shown to depend heavily on the design of the constellation and how frequently the satellites can communicate with one another. To explore how higher-level coordination can impact performance, a centralized mixed-integer programming optimization approach to global target distribution is explored and compared to a decentralized approach. A genetic algorithm is also implemented for comparison purposes, and the proposed method is shown to achieve higher reward on average at a fraction of the computational cost.

Adherence to Annual Lung Cancer Screening in a Centralized Academic Program

BackgroundAdherence to lung cancer screening (LCS) protocols is critical for achieving mortality reductions. However, adherence rates, particularly for recommended annual screening among patients with low-risk findings, are often sub-optimal. We evaluated annual LCS adherence for patients with low-risk findings participating in a centralized screening program at a tertiary academic center. Patients and MethodsWe conducted a retrospective, observational cohort study of a centralized lung cancer screening program launched in July 2018. We performed electronic medical review of 337 patients who underwent low-dose CT (LDCT) screening before February 1, 2021 (to ensure ≥ 15 months follow up) and had a low-risk Lung-RADS score of 1 or 2. Captured data included patient characteristics (smoking history, Fagerstrom score, environmental exposures, lung cancer risk score), LDCT imaging dates, and Lung-RADS results. The primary outcome measure was adherence to annual screening. We used multivariable logistic regression models to identify factors associated with adherence. ResultsOverall, 337 patients had an initial Lung-RADS result of 1 (n = 189) or 2 (n = 148). Among this cohort, 139 (73.5%) of Lung-RADS 1 and 111 (75.0%) of Lung-RADS 2 patients completed the annual repeat LDCT within 15 months, respectively. The only patient characteristic associated with adherence was having Medicaid coverage; compared to having private insurance, Medicaid patients were less adherent (adjusted OR = 0.37, 95% CI = 0.15-0.92). No other patient characteristic was associated with adherence. ConclusionOur centralized screening program achieved a high initial annual adherence rate. Although LCS has first-dollar insurance coverage, other socioeconomic concerns may present barriers to annual screening for Medicaid recipients.

Hepatocellular carcinoma surveillance in Australia: current and future perspectives.

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide, and is increasing in incidence in Australia. For most people with cirrhosis and chronic hepatitis B, HCC screening and surveillance is recommended with 6-monthly ultrasound. However, most patients with HCC are still diagnosed outside of surveillance with incurable disease. While HCC surveillance almost certainly reduces cancer-related mortality, the potential harms of surveillance are incompletely understood. Surveillance uptake remains suboptimal in many contexts, and stems from a combination of patient, clinician and system level barriers. Improved case-finding strategies may be required to identify high risk individuals in need of surveillance, as cirrhosis and viral hepatitis are often asymptomatic. HCC prediction models and novel surveillance tools such as biomarker panels, computed tomography and magnetic resonance imaging may have a future role in personalised HCC surveillance. Analyses suggest surveillance may be cost-effective, but Australian data remain limited. A centralised HCC surveillance program may ultimately have a role in delivering improved and more equitable care.

Colposcopy referral rates post-introduction of primary screening with human papillomavirus testing: evidence from a large British Columbia cohort study

Shifting from cytology to human papillomavirus (HPV)-based cervical cancer screening will initially increase colposcopy referrals. The anticipated impact on health systems has been raised as a concern for implementation. It is unclear if the higher rate of colposcopy referrals is sustained after initial HPV-based screens or reverts to new lower baselines due to earlier detection and treatment of precancer. This study aimed to investigate long-term rates of colposcopy referrals after participation in HPV-based screening. Participants of HPV for Cervical Cancer Screening trial (HPV FOCAL) received one (HPV1, N=6204) or two (HPV2, N=9540) HPV-based screens. After exit, they returned to British Columbia's (BC) cytology screening program. A comparison cohort from the BC screening population (BCS, N=1,140,745) was identified, mirroring trial inclusion criteria. All participants were followed for 10-14 years through the provincial screening registry. Colposcopy referral rates per 1000 screens were calculated for each group. Trial colposcopy referrals for HPV1 and HPV2 were calculated under two referral scenarios: (1) all HPVpositivereferred to colposcopy; (2) cytology triage with ASCUSor greaterreferred to colposcopy. Colposcopy referrals from post-trial screens in HPV1 an HPV2 and all screens in BCS were based on actual recommendations from the screening program. A multivariable flexible survival regression model compared hazard ratios (HR) throughout follow-up. Scenario 2 referral rates were higher during initial HPV screen(s) vs cytology screen (HPV1: 28 per 1000 screens (95% CI: 24, 33), HPV2: 32 per 1000 screens (95% CI: 29, 36), BCS: 8 per 1000 screens (95% CI: 8.9)). However, post-trial rates in HPV1 and HPV2 were significantly lower than in BCS. Cumulative rates in HPV1 and HPV2 approached the cumulative rate in BCS 11-12 years after HPV-based screening (HPV1: 11 per 1000 screens (95% CI: 10, 12), HPV2: 16 per 1000 screens (95% CI: 15-17), BCS: 11 per 1000 screens (95% CI: 10, 11)). Adjusted models demonstrated reductions in referral rates in HPV1 (HR=0.6, 95% CI: 0.5, 0.7) and HPV2 (HR=0.7, 95% CI: 0.6, 0.8) relative to BCS by 54 and 72 months post-final HPV screen respectively. Reduced colposcopy referral rates were observed after initial rounds of HPV-based screening. After initial HPV screening, referral rates to colposcopy after cytology triage were below the current rates seen in a centralized cytology program after approximately four years. Any expected increase in referrals at initiation of HPV-based screening could be countered by staged program implementation. This work was supported by the National Institutes of Health (R01 CA221918), Michael Smith Health Research BC (RT-2021-1595), and the Canadian Institutes of Health Research (MCT82072).

Impact of a centralized population health pharmacy program on value-based Medicare patients

BackgroundMemorial Healthcare System (MHS) participated in the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement Advanced value-based program aimed to improve patient care and reduce health care costs. Challenges with medication therapy problems (MTPs) led to the development of a centralized tele-health population health pharmacy program. This innovative approach aimed to provide comprehensive postdischarge medication support and resolve MTPs during the 90-day risk period. ObjectivesThe program aimed to provide longitudinal medication support, resolve MTPs, and affect 90-day readmission rates. Practice descriptionMHS established uniform workflows, a pharmacy task force, and a dual pharmacy team approach with population health registered nurses (PHRNs). The population health pharmacists (PHPs) conducted postdischarge telephonic encounters to resolve MTPs longitudinally throughout the risk period. Practice innovationThe program used a centralized tele-health model with electronic health record–integrated tools. It targeted readmission rates up to 90 days, beyond the conventional 30-day period. PHPs collaborated with onsite transitions of care pharmacists, PHRNs, and health care professionals for coordinated patient care and MTP resolution. Evaluation methodsA retrospective analysis using descriptive statistics, a Kruskal-Wallis test, and multivariate regression models after stratifying patients into 4 groups were used to assess MTP resolution rates and differences in readmission rates. ResultsOver 7 months, PHPs completed 801 telephonic visits, identifying 433 MTPs with a 94% resolution rate. The program led to a statistically significant reduction in 90-day readmission rates from 35% to a range of 10%-17% (P < 0.01). ConclusionThe centralized tele-health population health pharmacy program improved patient outcomes, resolved MTPs, and reduced readmission rates. The program serves as a model for integrating pharmacists into value-based care initiatives.

HIV Viral Load Testing in the South African Public Health Setting in the Context of Evolving ART Guidelines and Advances in Technology, 2013-2022.

HIV viral load (VL) testing plays a key role in the clinical management of HIV as a marker of adherence and antiretroviral efficacy. To date, national and international antiretroviral treatment recommendations have evolved to endorse routine VL testing. South Africa (SA) has recommended routine VL testing since 2004. Progressively, the centralised HIV VL program managed by its National Health Laboratory Service (NHLS) has undergone expansive growth. Retrospective de-identified VL data from 2013 to 2022 were evaluated to review program performance. Test volumes increased from 1,961,720 performed in 2013 to 45,334,864 in 2022. The median total in-laboratory turnaround time (TAT) ranged from 94 h (2015) to 51 h (2022). Implementation of two new assays improved median TATs in all laboratories. Samples of VL greater than 1000 copies/mL declined steadily. Despite initial increases, samples of fewer than 50 copies/mL stagnated at about 70% from 2019 and declined to 68% in 2022. Some variations between assays were observed. Overall, the SA VL program is successful. The scale of the VL program, the largest of its kind in the world by some margin, provides lessons for future public health programs dependent on laboratories for patient outcome and program performance monitoring.

Implementing a Telehealth Shared Counseling and Decision-Making Visit for Lung Cancer Screening in a Veterans Affairs Medical Center.

Veterans suffer substantial morbidity and mortality from lung cancer. Lung cancer screening (LCS) with low-dose computed tomography (LDCT) can reduce mortality. Guidelines recommend counseling and shared decision-making (SDM) to address the benefits and harms of screening and the importance of tobacco cessation before patients undergo screening. We implemented a centralized LCS program at the Iowa City Veterans Affairs Medical Center with a nurse program coordinator (NPC)-led telephone visit. Our multidisciplinary team ensured that veterans referred from primary care met eligibility criteria, that LDCT results were correctly coded by radiology, and that pulmonary promptly evaluated abnormal LDCT. The NPC mailed a decision aid to the veteran and scheduled a SDM telephone visit. We surveyed veterans after the visit using validated measures to assess knowledge, decisional conflict, and quality of decision making. We conducted 105 SDM visits, and 91 veterans agreed to LDCT. Overall, 84% of veterans reported no decisional conflict, and 59% reported high-quality decision making. While most veterans correctly answered questions about the harms of radiation, false-positive results, and overdiagnosis, few knew when to stop screening, and most overestimated the benefit of screening and the predictive value of an abnormal scan. Tobacco cessation interventions were offered to 72 currently smoking veterans. We successfully implemented an LCS program that provides SDM and tobacco cessation support using a centralized telehealth model. While veterans were confident about screening decisions, knowledge testing indicated important deficits, and many did not engage meaningfully in SDM. Clinicians should frame the decision as patient centered at the time of referral, highlight the importance of SDM, and be able to provide adequate decision support.

Distributed coordinated planning for cross-border energy system: An ADMM-based decentralized approach

Cross-border interconnection and trade (CBIT) can effectively leverage the differences in resource endowments and energy demand between regions and countries, making cross-border cooperation a potential option for addressing the high penetration of variable renewable energy. This paper presents centralized and decentralized planning approaches for the cross-border energy transmission expansion planning (TEP) problem. The proposed centralized mixed-integer second-order cone programming (MISOCP) model collaboratively optimizes the expansion of national energy networks, while considering the impact of CBIT. To protect the privacy of energy data in each country, the alternating direction method of multipliers (ADMM) algorithm is extended to decompose the centralized optimization formulation into mutually independent sub-optimization issues, and adaptively adjust the penalty parameters and Lagrangian multipliers to improve convergence. This study also quantifies the effect of cross-border cooperation in such co-expansion problems as a comparative consideration. Numerical simulations on the modified cross-border integrated energy network validates the correctness and effectiveness of the proposed model and solution methodology. The results show that cross-border cooperation can reduce a country's internal energy network congestion, thus postponing the expansion investment decisions. It also shows that the distributed coordinated planning is more efficient in terms of lower cost and renewable generation curtailment that than independent optimization method. Therefore, cross-border collaboration brings economic, environmental, and renewable integration benefits to interconnected countries.

National lung cancer screening rates among women veterans within the Veterans’ Health Administration.

1543 Background: Lung cancer is the number one cause of cancer related death among women in the United States. United States Preventive Services Task Force (USPTF) lung cancer screening (LCS) guidelines recommend annual low dose computed tomography (LDCT) among high-risk populations. The data specifically on women veterans is sparse so we retrospectively examined LCS rates among women veterans within the VHA. Methods: Women veterans ages 50-80, current or former (quit within 15 years) smokers from 2013- 2021 were identified through the VA corporate data warehouse (CDW). Captured characteristics included: demographics, smoking history, and cancer screening history (lung, breast, cervical). Data was analyzed using R Studio software. Results: Women veterans with a history of smoking (n=40,299) tended to be aged ≥60, white (66%), single (69%), unemployed (64%), urban dwelling (67%), and residing in Southeast U.S. (31%). Overall, cancer screening rates among women veterans was low (9% lung; 27% breast; 21% cervical). Of the women not screened for lung cancer (91%; n=36,837), 11% (n=4, 016) had a personal history of cancer. While pack-year history was not documented for the vast majority (92%), 7% (n= 2, 729) reported a &gt;30 pack-year smoking history (guideline at the time). Of these &gt;30 pack-year smokers, 88% (n=2,418) were not screened for lung cancer. Other significant demographic predictors of increased LCS rates included Southeast Veterans Integrated Service Network (VISN region) and comorbidities such as bipolar disorder and diabetes likely due to increased exposure to healthcare. Conclusions: LCS rates, as well as breast and cervical, among women veterans within the VHA is low. The lack of documented pack-year history among women veterans with a history of smoking is concerning. Increased documentation of pack-year history may aid in identifying women for LCS. Efforts are ongoing nationally to implement an equitable centralized LCS program for all veterans and as part of that effort the Birmingham VA Health Care System has utilized their Lung precision Oncology program (LPOP) funding to pilot a structured lung cancer screening program within our Women’s Health Clinic in 2022.

Colorectal Cancer Clinical Trial Summit: Devising solutions and interventions.

e15603 Background: Only 5% of adult cancer patients enroll in cancer clinical trials; however, approximately 70% are willing to participate. The numerous gaps between patient willingness and trial participation rates suggest that enrollment in clinical trials can be challenging. The Colorectal Cancer Alliance Clinical Trial Think Tank Summit brought together multidisciplinary voices to propose solutions and tailor interventions to increase participation in colorectal cancer (CRC) clinical trials and save lives. Methods: An expert advisory committee supported the planning of the Summit by collating existing knowledge and best practices from across the field. The Alliance collected patient perspectives through interviews and aligned around three critical themes for change in CRC clinical trials. The Summit created a forum for thoughtful and strategic discussions with expert speakers and sessions to explore thematic solutions. Results: The advisory committee’s research activities and discussion identified strategic solutions across the following themes: 1. Marketing &amp; Messaging Trust in Clinical Trials; 2. Fostering Readiness for Community-Based Cancer Research, and 3. Clinical Trial Patient Navigation. There was consensus that cancer patients and the public need to be educated on the importance of clinical trial access and dispel myths about clinical trials. Messaging must be culturally competent, creating quality standards for trial awareness and participation for utilization in a marketing campaign.&amp;nbsp; Summit participants discussed barriers to clinical trial enrollment at the institutional, structural, provider, and patient levels. Collaborations with industry sponsors and partnering with community oncology programs are necessary for designing and conducting research serving the understudied and underserved. &amp;nbsp; Participants identified that navigators are crucial for decentralized clinical trials and are a key element for improving clinical trial efficiency and the patient experience. Developing and launching a centralized clinical trial navigator pilot program is necessary to ensure that navigators are knowledgeable about recruiting CRC clinical trials nationally. Conclusions: Clinical trials are essential to advancing new treatments. To extend clinical research into the community, standardized messaging is needed that dispels myths about clinical trials and highlights positive trial outcomes. By improving our overall messaging, collaboration, education, and access to resources, we can accelerate CRC clinical trial participation to improve outcomes and research answers.

National Survey of Lung Cancer Screening Practices in Veterans Health Administration Facilities

Lung cancer screening can save lives through the early detection of lung cancer, and professional societies recommend key lung cancer screening program components to ensure high-quality screening. Yet, little is known about the key components that comprise the various screening program models in routine clinical settings. The objective was to compare the utilization of these key components across centralized, hybrid, and decentralized lung cancer screening programs. The survey was designed to identify current structures and processes of lung cancer screening programs. It was administered electronically to Veterans Health Administration facilities nationally (N=122) between August and December 2021. Results were analyzed between March and August 2022 and stratified by self-identified lung cancer screening program type, and we tested the hypothesis that centralized screening programs would be more likely to have implemented practices that support lung cancer screening, followed by hybrid and decentralized programs, using the Cochran-Armitage trend test. Overall, 69 (56.6%) facilities completed the survey, and respondents were lung cancer screening coordinators (39.1%), pulmonologists (33.3%), and oncologists (10.1%). Facilities most frequently self-identified as having a centralized (37.7%) program model, followed by identifying as having hybrid (30.4%) and decentralized (20.3%) programs. There was varying implementation of practices to support lung cancer screening, with hybrid and decentralized programs less likely to have lung cancer screening registries, lung cancer screening steering committees, or dedicated lung cancer screening coordinators. Although there is overlap between the components of various lung cancer screening program types, centralized programs more frequently implemented practices before the initial screening to support lung cancer screening. This work provides a path for future investigations to identify which lung cancer screening practices are effective to improve lung cancer screening outcomes, which could help inform implementation in settings with limited resources.