Implementation of an Integrated Lung Cancer Screening Program at a Large Academic Community Health System in the U.S.
Journal of Thoracic Oncology
Introduction: Low dose CT (LDCT) for lung cancer screening is used to detect lung cancers earlier and improve lung cancer survival. The U.S. Preventive Services Task Force (USPSTF) established updated guidelines in March, 2021 and these were incorporated into our program. Our lung cancer leadership committee prioritized implementation of these updated guidelines in our system to increase lung cancer screening. This report details the steps we implemented from 2020- 2022 and the resulting increase in lung cancer screening. Methods: In 2019, we established a multi-disciplinary lung cancer steering committee to prioritize and advance the quality of lung cancer care from screening through survivorship to improve lung cancer survival and quality of life. The committee is composed of providers representing various parts of our system which includes 8 hospitals, 150 outpatient locations, 28 affiliated urgent care centers and physician practices. Our team set a goal in 2020 to increase LDCT studies ordered systemwide by 25% each year from 2020-2022. We developed ideas to raise awareness of the updated USPSTF guidelines and increase the volume of eligible patients getting screened. These implementations included: 1) embedding a tool in our electronic medical record to create automatic reminders to providers that an individual is eligible for lung cancer screening, 2) distributing pamphlets to eligible individuals in urgent care centers, 3) collaborating with breast care and mammography centers to raise awareness in people getting mammography for breast cancer screening to review eligibility for lung cancer screening, 4) presenting the updated USPSTF guidelines at tumor boards, primary care conferences, and staff meetings, 5) conducting community lung cancer awareness events, and 6) distributing LDCT screening informational pamphlets throughout the system. Results: Implementation of the above measures have increased lung cancer screening orders by over 25% during a three-year period from 3/2020 through 3/2023. Graph 1 demonstrates this increase reported from eight designated geographical care regions. Compliance rates were >90% in terms of continued distribution of resources. All 28 urgent care centers reported continued distribution. Over 1500 community members attended our 2020-2022 lung cancer awareness events. Conclusions: This report details strategies that can be employed by health systems to increase their LDCT lung cancer screening volumes. Our demonstrated 25% increase of screening orders is especially gratifying given this increase was during the time of the COVID pandemic. In spite of competing priorities and challenges, our implementations were well-received by providers and eligible individuals.
Stromberg J, Grills I, Watson T, Kupovits C, Sessa B, Al-Katib S, Stevens C. Implementation of an integrated lung cancer screening program at a large academic community health system in the U.S. J Thorac Oncol. 2023 Nov;18(11 Suppl.):S460. doi:10.1016/j.jtho.2023.09.844