Author/Authors :
Wilshire, Candice L. Division of Interventional Pulmonology and Thoracic Surgery - Swedish Cancer Institute, Seattle, USA , Fuller, Carson C. Division of Interventional Pulmonology and Thoracic Surgery - Swedish Cancer Institute, Seattle, USA , Gilbert, Christopher R. Division of Interventional Pulmonology and Thoracic Surgery - Swedish Cancer Institute, Seattle, USA , Handy, John R. Department of Thoracic Surgery - Providence Health and Services, Portland, USA , Costas, Kimberly E. Department of Thoracic Surgery - Providence Medical Group, Everett, USA , Louie, Brian E. Division of Interventional Pulmonology and Thoracic Surgery - Swedish Cancer Institute, Seattle, USA , Aye, Ralph W. Division of Interventional Pulmonology and Thoracic Surgery - Swedish Cancer Institute, Seattle, USA , Farivar, Alexander S. Division of Interventional Pulmonology and Thoracic Surgery - Swedish Cancer Institute, Seattle, USA , Vallieres, Eric Division of Interventional Pulmonology and Thoracic Surgery - Swedish Cancer Institute, Seattle, USA , Gorden, Jed A. Division of Interventional Pulmonology and Thoracic Surgery - Swedish Cancer Institute, Seattle, USA
Abstract :
,e National Comprehensive Cancer Network expanded their lung cancer screening (LCS) criteria to comprise one additional
clinical risk factor, including chronic obstructive pulmonary disease (COPD). ,e electronic medical record (EMR) is a source of
clinical information that could identify high-risk populations for LCS, including a diagnosis of COPD; however, an unsubstantiated COPD diagnosis in the EMR may lead to inappropriate LCS referrals. We aimed to detect the prevalence of unsubstantiated COPD diagnosis in the EMR for LCS referrals, to determine the efficacy of utilizing the EMR as an accurate
population-based eligibility screening “trigger” using modified clinical criteria. We performed a multicenter review of all individuals referred to three LCS programs from 2012 to 2015. Each individual’s EMR was searched for COPD diagnostic terms and
the presence of a diagnostic pulmonary functionality test (PFT). An unsubstantiated COPD diagnosis was defined by an individual’s EMR containing a COPD term with no PFTs present, or the presence of PFTs without evidence of obstruction. A total of
2834 referred individuals were identified, of which 30% (840/2834) had a COPD term present in their EMR. Of these, 68% (571/
840) were considered unsubstantiated diagnoses: 86% (489/571) due to absent PFTs and 14% (82/571) due to PFTs demonstrating
no evidence of postbronchodilation obstruction. A large proportion of individuals referred for LCS may have an unsubstantiated
COPD diagnosis within their EMR. ,us, utilizing the EMR as a population-based eligibility screening tool, employing expanded
criteria, may lead to individuals being referred, potentially, inappropriately for LCS.
