A multi-level system quality improvement project to reduce disparities in lung cancer screening: The Sylvester Lung Screening Project.

Abstract

6518 Background: Racial disparities in lung cancer mortality and screening have been well documented in the USA. Annual screening with low dose Computed Tomography (CT) scans is completed in fewer than 6% of the eligible population. Research suggests that many factors contribute to low screening uptake, including barriers to care at patient, clinician, healthcare system, and community levels. In collaboration with the American Cancer Society, the University of Miami/ Sylvester Cancer Center underwent a multi-level system quality improvement (QI) project with the goal to decrease lung cancer screening disparities and improve guideline concordant lung cancer screening across the health care system. Methods: During the one-year multi-level QI project, interventions were put into place to increase lung cancer screening exams via improvements in EMR- identification of eligible patients, patient navigation and expanded provider education services in primary care clinics. Patient level interventions included a marketing campaign, patient navigation, and interpreters to address language barriers. The Patient-interface of the EMR ‘Health Maintenance Gap’ was optimized to alert eligible patients about screening. In addition, a full-time lung cancer screening navigator provided culturally competent, patient-centered counseling, while allowing for an increased capability to manage a higher volume of patients. Provider level interventions included teaching sessions about lung cancer screening and motivational communication skills, and BPA alerts. The primary outcome was the change in the number of screened patients. Results: With the implementation of these multi-level interventions, there was a twenty five percent improvement in the number of lung cancer screening exams completed during the project period January 2022- December 2022 compared to 2021 baseline, from 20 to 25%. The screening rate was highest among Hispanics (12%), followed by Blacks (8%), and Non- Hispanic Whites (NHW) (6%). The majority of LDCT results were Lung RADS Category 1 or 2 (93%). Conclusions: Multi-level interventions that target patients, clinicians, and the health care system can improve lung cancer screening rates in a short-term period. Developing patient-centered, culturally competent interventions is key to reducing disparities in lung cancer screening. This QI intervention was strengthened by tailoring intervention components to the educational primary care physicians and simplifying the referral process. [Table: see text]