Implementing Lynch Syndrome Screening in the Veterans Health Administration

Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Diagnosis of LS has important clinical implications for CRC patients and their family members. LS screening in tumor tissue is possible, and screen-positive cases are referred for diagnostic testing. This case study describes how implementation science informed a population-based LS screening program in the Veterans Health Administration (VHA), the largest integrated health care delivery system in the United States. Successful implementation strategies relied on the organizational structures and processes characteristic of integrated health care systems, including data warehousing methods that leverage the electronic health record, case management, and centralized technical assistance. Challenges to sustainability of the population-based program include low prevalence of LS among veterans, limited expertise, organizational changes, and the rapidly evolving field of precision oncology. LS screening is an exemplar case study for implementation science in integrated health care delivery systems.