Multimodal interventions targeting identified barriers to improve lung cancer screening in northeast Georgia.

Abstract

6570 Background: Lung cancer is the leading cause of cancer deaths with over 50% of patients diagnosed at an advanced stage. Lung cancer screening (LCS) guidelines were recently updated in 2021, which expanded the age group and reduced the pack years, and thereby increased eligibility. However, the underutilization of low dose computed tomography (LDCT) scans is seen nationwide. In 2015, the National Health Interview Survey found that only 3.9% of eligible adults underwent LCS. The barriers for LCS identified in national literature included failure of electronic medical records (EMR) to notify providers of eligible patients, lack of insurance coverage, patient refusal, and lack of patient and provider awareness. This quality improvement project was performed to improve LCS in primary care clinics (graduate medical education [GME] and non-GME) at a tertiary medical center in northeast Georgia by addressing these barriers. Methods: In GME clinics, the goal was to double LDCT scans from 14 to 28 monthly. In non-GME clinics, the goal was to increase LDCT scans by at least 50% from 28 to 42 weekly. LDCT scans performed between January 1st to May 31st 2022 was used as baseline data. The interventions spanned over six months, from June 1st to November 30th 2022. Multimodal interventions were used to target various barriers. Accurate tobacco history in the EMR was improved by participating in the nationwide Just Ask Campaign. Flyers posted in clinics provided information on current guidelines and a QR code for patients to determine their LCS eligibility. Provider reference guides highlighted LCS guidelines and billing codes. Community events and social media were used to spread LCS awareness. Results: During the implementation phase, the average monthly LDCT scans increased to 23 scans in GME clinics and 40 scans weekly in non-GME clinics. In GME clinics, the goal of 28 scans monthly was achieved in one out of six months. In non-GME clinics, the goal of 42 scans weekly was surpassed in four out of six months. The Long-Range Acoustic Device (L-RAD) scoring system helped diagnose three cancers in the GME clinics and about one cancer for every 10 L-RAD4 in non-GME clinics. The baseline period LDCT scans of 78 (GME) and 656 (non-GME) increased to 177 (GME) and 1109 (non-GME) during the intervention period. Conclusions: This multimodal approach in addressing known barriers to increase LCS across primary care clinics in a single healthcare system is feasible and was associated with short-term improvements. Although the targets were not met every month, there was a notable improvement during the intervention period. A major limitation was the inability to determine which intervention had the greatest impact. A newly identified barrier was the lack of follow up scans being ordered by providers. This project demonstrates the potential to increase LCS using a multimodal approach, which can be implemented in similar healthcare systems.