BRIDGING THE GAP TO IMPROVE THE RATE OF LUNG CANCER SCREENING IN A MINORITY POPULATION: A QUALITY IMPROVEMENT INITIATIVE IN A COMMUNITY HOSPITAL

Abstract

TOPIC: Lung Cancer TYPE: Original Investigations PURPOSE: The rate of lung cancer cases in New York City has decreased from 51.5 per 100,000 population in 1976 to 46.9 per 100,000 population in 2017. Over that same time period, the number of cases has steadily increased from 3929 cases per year in 1976 to 4507 cases per year in 2017. Mortality rate has decreased during this same time period from 42.0 per 100,000 to 24.0 per 100,000. This is likely due to an increased rate of screening protocols for lung cancer and subsequent earlier interventions. The National Lung Cancer Screening Trial (NLCST) showed a 15-20% lower risk of dying from lung cancer with participants who received low dose computed tomography (LDCT) scan versus participants who received standard chest radiograph. Data from our institution has shown that the rate of lung cancer screening studies are estimated at 10%. Studies have shown that the inadequate assessment of smoking history was a fundamental barrier to identify screen appropriate populations. The purpose of this study is to increase the rate of lung cancer screening in our patient population with a quality improvement project to identify smoking history. METHODS: A team of internal medicine residents conducted a retrospective chart review of 452 patients seen in our outpatient clinic over a period of 6 months. We updated the smoking history documentation for all of the patients and then we identified the age appropriate screening population based on the United States Preventive Services Task Force (USPSTF) guidelines for LDCT. The primary care physicians for this population were then notified to schedule a referral to the cancer screening coordinator in order to arrange LDCT screening. Our process measure was new referrals for LDCT. RESULTS: First we identified patients who were eligible for LDCT based on prior documentation; this was 21 patients (4.6%). After updating the smoking history, 89 patients (19.7%) were eligible for LDCT as per USPSTF guidelines. Of these patients, 16 (18%) had pending referrals to our screening coordinator, leaving a population of 73 (82%) patients who were not referred for screening. Due to our intervention, 23 (31.5%) patient were referred for LDCT. This represents a 6% increase in the number of referrals for age appropriate lung cancer screening. CONCLUSIONS: Our study has shown that with proper documentation of smoking history, you can increase the rate of referrals for age appropriate lung cancer screening which would in turn lead to earlier detection and treatment. Providing education and EMR alerts to raise awareness regarding screening eligibility would substantially increased the screening rate in our clinics. CLINICAL IMPLICATIONS: Research has shown that screening for lung cancer with LDCT has shown to decrease mortality and with proper documentation, the number of persons referred for LDCT could be increased which may in turn lead to early detection and treatment for lung cancer. DISCLOSURES: No relevant relationships by Sai Achi, source=Web Response No relevant relationships by Raji Ayinla, source=Web Response No relevant relationships by Janet Joseph, source=Web Response No relevant relationships by Richard Sheppard, source=Web Response