Organizational preparedness for implementing an evidence-based multilevel intervention to improve the timeliness of lung cancer treatment.

[BACKGROUND] Delayed time to treatment is a key determinant of poor survival among patients with lung cancer. Factors affecting the timeliness of lung cancer treatment are multilevel in nature. Most interventions target only 1 level of influence. Existing evidence-based interventions that work in 1 setting may fail to work in a different setting owing to poor fit in the new setting or deviations from the original intervention. Our study evaluated the feasibility of adopting a Veterans Health Administration (VHA) evidence-based multilevel intervention (EBMLI) within an academic health system.

[METHODS] The VHA EBMLI is a multilevel lung cancer care coordination program previously used by the VHA targeting the individual, provider team, and organization levels. The intervention effectively reduced time to treatment for Veterans with lung cancer over 7 years with statistically significant individual-level reductions by approximately 50%. We conducted a survey of providers across 5 sites on the acceptability, appropriateness, and feasibility toward the EBMLI using the following validated scales: (1) acceptability of intervention measure (AIM) (score range 1-5), (2) intervention appropriateness measure (IAM) (1-5), (3) feasibility of intervention measure (FIM) (1-5), (4) implementation climate scale (ICS) (0-4), and (5) implementation leadership scale (ILS) (0-4).

[RESULTS] A total of 45 providers consented to participate in the survey, and 36 (mean age 46 ± 11 years) across 5 sites completed the survey. Most had MD or PhD degrees (46%), were physicians (42%), and had >10 years' health care experience (49%) with 20 ± 20 patients with lung cancer seen per week, of whom 60% of providers saw only adult patients. Mean scores on the scales were AIM (4.1 ± 0.8), IAM (4.0 ± 0.8), FIM (4.1 ± 0.8), ICS (2.7 ± 0.7), and ILS (3.2 ± 0.9).

[CONCLUSION] Although the proposed EBMLI may be well received by providers and leadership, acknowledgment of contexts affecting organizational climate is needed to ensure the feasibility of the adaptation, implementation, and sustainability of the VHA EBMLI.