P3.11-06 Improving Lung Cancer Screening Completion Rates in a Primary Care Practice in Large Urban Academic Medical Center

Abstract

Despite implementation of a physician-facing electronic health record (EHR) best practice alert (BPA) with robust medical decision making and documentation, only 7.3% of eligible patients (85 of 1170) throughout the institution completed a low-dose CT (LDCT) for lung cancer screening in 6 months (May 1st to November 1, 2017). The objective is to improve lung cancer screening by: 1. Describing primary care referral patterns and status among eligible patients 2. Identifying system, patient and provider-level barriers to referral and completion 3. Developing and testing targeted interventions Success will be measured by reducing number of eligible patients overdue for screening by 50% in the next 6 months. An Epic EHR report identified patients with an overdue lung cancer screening BPA within one practice representing approximately 40% of primary care (16,000 visits in 6 months). Through chart review, we quantified number of patients at different points of the referral pathway. New interventions were developed for the most common categories of patients overdue for screening: Those with orders that had not scheduled the exam and those with no order and no documentation of why in the EHR. Lung Cancer Screening Coordinators contacted patients with current orders and began scheduling LDCT exams. (Intervention 1). Division leadership, medical directors, primary care providers (PCP), and the practice nurse manager were engaged to design an intervention to address patients with no LDCT order (Intervention 2) The total number of LDCTs performed in the first 12 weeks after starting the intervention was almost equal to the performed in the 6 month baseline period. (12 vs 14). The percentage of patients overdue with orders increased from 28% to 37.5%. Only 7 of the original 18 with orders not scheduled remained in that category at 12 weeks. The percentage of patients overdue with no order and no documentation decreased from 65.9% of to 51.3%. Fifteen of 41 with no order and no reason documented (36.5%) were newly identified at 12 weeks, i.e. not identified by the baseline query. The most significant limitation to measuring 12-week outcomes is that patients have not yet completed their scheduled PCP appointments and LDCT appointments. Multiple challenges were identified at system, patient and provider levels: *The BPA lacks specificity. *This patient subpopulation has a high prevalence of comorbidities and chronic conditions. *PCPs expressed skepticism regarding evidence for lung cancer screening, perceived lack of benefit for some patients and competing demands.