Improving Lung Cancer Screening through Community Care

July 21, 2026

Takeaway: The Community 'Referral Coordination Initiative' (VA Minneapolis Healthcare System increased appropriate pulmonary consultation for suspicious lung nodules from 45% to 100%. Successful results of this study have been shared with leaders from VISN 23 and the Lung Precision Oncology Program (LPOP). These findings helped inform the national launch of an initiative developed to incorporate care in the community into VA lung cancer screening programs.

Background

Lung cancer is the leading cause of cancer-related deaths among Veterans. Each year approximately 7,500 Veterans are diagnosed with lung cancer, with more than half having advanced cancer (Ramos, et al., 2025). Lung cancer screening (LCS) is a life-saving clinical program for early lung cancer detection. VA requires that eligible patients be offered LCS; however, Veterans living in rural settings may have geographic barriers to accessing LCS and often use care in the community (CITC) to receive this screening, placing them at risk of care fragmentation for what may be a complex, protracted process.

Through the support of a VISN 23 Strategic Initiative, this project sought to improve the quality of incorporating care in the community into VA lung cancer screening programs. As part of this work, investigators developed a comprehensive CITC lung cancer screening process. This process leveraged existing VA informatics tools and incorporated CITC LCS patients into an established centralized screening program, creating a new position for a CITC LCS nurse coordinator.

Care in the Community 'Referral Coordination Initiative'

In 2019, VA updated its process for scheduling specialty care appointments. Under this process, titled the Referral Coordination Initiative (RCI), referral coordination teams at VA medical facilities review referrals for specialty care, including the expansion of lung cancer screening programs, and discuss care options with Veterans.

Dr. Anne Melzer and colleagues developed a program to determine whether the implementation of a centralized process for CITC LCS would:

• Improve the timeliness of care,
• Decrease care fragmentation by recapturing imaging and consultative care within the VA healthcare system, and
• Increase appropriate imaging follow-up and specialty consultation for lung nodules identified through lung cancer screening.

Findings showed that integrating CITC LCS into the formal LCS program resulted in improved guideline-adherent LCS, increased appropriate consultative care, decreased care fragmentation, and improved staff experience.

In the first year of the program, Dr. Melzer and colleagues processed more than 3,000 consults through the newly established Care in the Community 'LCS Referral Coordination Initiative' at VA Minneapolis Health Care System, finding that:

• Appropriate pulmonary consultation for suspicious lung nodules increased from 45% to 100%;
• 19% of patients eligible for community care were recaptured into VA; and
• 100% of community care patients were integrated into VA's centralized screening program.

At the second pilot site at VA Fargo Healthcare System, more than 1,400 consults were processed with 18% of community care-eligible Veterans recaptured into VA imaging.

This program rapidly demonstrated considerable impact on implementation of high-quality Lung Cancer Screening for predominantly rural Veterans at sites across VISN 23. Moreover, VA's National Center for Lung Cancer Screening (NCLCS) determined all VAs needed to incorporate care in the community lung cancer screening into their lung cancer screening programs. In FY2025, the Minneapolis team met multiple times with national stakeholders from key offices (e.g., Radiology, NCLCS) to inform the national roll-out.

Implications

These successful results have been shared with leaders from VISN 23 and the Lung Precision Oncology Program (LPOP) and were presented at the LPOP conference (2024) and the American Thoracic Society International Conference (2024). Findings helped inform the national launch of an initiative developed to incorporate care in the community into VA lung cancer screening programs.

Partner

VISN 23 (VA Midwest Healthcare Network).

Investigator

Anne Melzer, MD, MS, is a core investigator with HSR's Center for Care Delivery and Outcomes Research (CCDOR). She is also a physician in Pulmonary and Critical Care at VA Minneapolis Healthcare.

Citations