Systems-Level Resources for Pulmonary Nodule Evaluation in the United States: A National Survey.

Each year, more than 1.5 million Americans are found to have a pulmonary nodule (1). As lung cancer screening becomes prevalent, still more nodules will be identified. Whether detected incidentally or through screening, guidelines recommend evaluating pulmonary nodules in a timely fashion to identify the subset that are malignant. Yet patients with pulmonary nodules often do not receive appropriate evaluation, seemingly “falling through the cracks” (2, 3). Systems-level structures and processes of care have been proposed to facilitate appropriate, efficient nodule evaluation (4–8), and indeed, clinicians have indicated that such system-level resources are essential to avoid loss to follow-up (9). However, the degree to which these structures and processes of care have been implemented nationally is unclear, and the American Thoracic Society (ATS) has called for more research in this area (10). We conducted a survey of ATS clinicians to characterize the availability of system-level resources to facilitate pulmonary nodule evaluation in the United States.