Abstract Introduction Lung cancer is the leading cause of cancer-related mortality in the U.S., yet screening rates are low nationally (16%),1 and even lower in the state of Oklahoma ( 8.6-11.5%).2 At the OU Internal Medicine (IM) Residency Clinic, current lung cancer screening rates are undocumented. This quality improvement project aims to establish baseline screening rates in the clinic, identify barriers to adherence, and implement interventions to improve awareness and guideline-concordant screening for early detection, timely treatment, and improved survival. Methods Inclusion criteria included patients who fit USPSTF recommended guidelines for lung cancer screening and were seen at the OU IM Residency Clinic. Pre and post intervention patient data was obtained through the EMR by reviewing clinic visit notes and orders, with responses collected via Research Electronic Data Capture (REDCAP) surveys. Primary outcomes included low-dose computed tomography (LDCT) screening rates, referral rates, and post-referral scheduling rates. Secondary outcomes focused on documentation of smoking history in number of pack years. Three primary interventions were implemented: screening questionnaires at patient check-in (2/7/25), resident education on documentation of smoking history in pack years (2/14/25), and email distribution of proper protocol for ordering LDCT scans (2/14/25). Study #18143 was evaluated by the IRB and determined to not meet criteria for human subjects research. Results Pre and post intervention groups evaluated similar numbers of patients (367 vs 356), although the ratio of patients seen by IM residents compared to attendings increased from 45.6% to 57.9%. Inaccurate documentation of smoking history decreased from 22.3% to 14.3%, yet unknown number of pack years increased from 5.4% to 11.2%. A similar percentage of patients qualified for LDCT screening 33 (9%) and 29 (8%). Notably there was improvement in LDCTs ordered in qualifying patients as rates without 1 year LDCT decreased from 57.6% (19/33) to 48.3% (14/29). Of the referrals ordered which were scheduled, there was an improvement from 14% (1/7) to 40% (2/5) in the post-intervention group. A limitation of this study is the low power of patients who qualify for a LDCT who subsequently either complete a LDCT, are referred for an LDCT, or have an LDCT scheduled. Conclusion Our intervention has resulted in improved documentation of smoking history with a relative increase in LDCT completion for those who meet guideline criteria. We hope to continue to see improvements in lung cancer screening as more patient questionnaires are distributed and more residents are properly educated.
Chukwuma et al. (Fri,) studied this question.