B40-14 Improving Pulmonary Nodule Follow-Up for Veterans

Introduction

Indeterminate pulmonary nodules are frequently identified on routine chest imaging and through lung cancer screening, prompting expert evaluation. Appropriate risk stratification and follow-up is crucial for early diagnosis of lung cancer. The veteran population experiences increased risk and poorer 5-year lung cancer survival. Unfortunately, delayed or incomplete follow-up is common in both general and veteran populations which may lead to diagnostic delay and later-stage cancer at diagnosis. Repeat imaging is a common pathway for follow-up of indeterminate pulmonary nodules before determining the need for invasive diagnostic testing. We assessed adherence to planned repeat CT imaging for pulmonary nodule follow-up at the Rocky Mountain Regional Veterans Affairs Medical Center (RMRVAMC) and conducted an in-depth evaluation of barriers to inform targeted quality improvement.

Methods

We conducted a retrospective chart review of veterans evaluated in the pulmonary nodule clinic at RMRVAMC with a plan for interval CT imaging. Imaging follow-up timeliness was assessed by the difference between the provider-ordered CT date and the completion date. A delay in pulmonary nodule follow-up was defined as a difference between provider-ordered CT and CT completion of > 30 days. We also conducted process review and targeted interviews with key stakeholders to identify areas for intervention.

Results

Between January 2023 and December 2025, 102 CT scans ordered for pulmonary nodule surveillance were evaluated. 56 (55%) were completed within 30 days, and 46 (45%) were completed more than 30 days past the provider-ordered CT date. Of all scans, 9% were delayed by 31-60 days, 8% by 61-90 days, 12% by 91-120 days, 12% by > 120 days, and 5% had no follow-up. Data showed a right-skewed distribution, with 28% of CTs occurring more than 90 days after the provider-ordered CT date. These data demonstrate a need for improvement in adherence to planned nodule follow-up. Areas identified for improvement included: CT Scheduling; Communication (including between provider-patient, radiologist-provider, and provider- provider); and Follow-up Tracking.

Conclusion

Pulmonary nodule follow-up is critical to preventing missed lung cancer diagnoses, especially within the veteran community, which has a higher lifetime risk of lung cancer. Our retrospective analysis found that 45% of patients experienced follow-up delays >30 days, and 28% >90 days. These results highlight opportunities to address barriers to achieving timely and guideline-concordant care throughout the pulmonary nodule follow-up process to improve the quality of nodule surveillance for our veterans.

This abstract is funded by: K. Louise Coulter Pulmonary Research Award