Marstein, EgilTackett, Scott MichaelBabich, SuzanneCulbertson, Richard2025-05-272025-05-272025-05https://hdl.handle.net/1805/48354IUIObjective: Investigate structural factors impacting the prioritization and funding of public health preventive lung cancer screening programs in U.S. hospitals. Additionally, provide change leadership recommendations on policies to improve the implementation of evidence-based practices. Data sources and study setting: Data was gathered through a systematic literature review and primary qualitative research from health system or hospital organizational leadership across the U.S. Study design: The research employed a descriptive, non-experimental, convergent mixed-methods approach. Quantitative and qualitative data were collected and analyzed independently, then combined to obtain detailed insights from various perspectives across a diverse system for a situational analysis. Data Collection and Methods: A systematic literature review, combined with semi-structured interviews with Chief Medical Officers, Chief Financial Officers, and lung cancer program executives, was conducted across U.S. hospitals and health systems. Purposive sampling included thirteen dyad executive pairs and two executives from integrated delivery network lung cancer programs, representing various regions with a 'representative voice' of 6% of U.S. hospitals. Principal findings: The data synthesis identified 18 factors affecting lung cancer screening programs, categorized into five themes: differing missions, governance models, misaligned economics, competing goals, and broad agreements. These themes illustrate national discussions influencing the implementation of these types of preventive public health programs in hospitals and integrated delivery network organizations. Discussion: Despite efforts to implement evidence-based practices, outcomes and annual adherence rates remain low, showing room for improvement. This study is the first to provide empirical evidence that system-level factors in healthcare governance, processes, economics, and strategic decisions significantly influence the prioritization and investment in lung cancer screening programs and initiatives to implement an evidence-based practice. Summary & Conclusions: CMS should implement policies linking quality measurement with economic incentives in lung cancer care. These policies aim to prioritize investments supporting implementation practices. Their adoption requires political and agency leadership and represents a significant shift in approach. Aligning with these types of motivating economic incentive policies could impact the entire U.S. healthcare system.en-USeconomicshealth policieshospital executiveimplementation sciencelung cancer screeningstructural determinantsThesis