Early implementation of a lung cancer screening program in a safety-net health system.

e22524 Background: Lung cancer screening (LCS) with low-dose CT reduces lung cancer mortality but remains underutilized in safety-net health systems. Barriers extend beyond eligibility criteria and include incomplete tobacco use documentation, fragmented referral workflows, limited care coordination, and challenges ensuring follow-up. We evaluated baseline gaps in LCS identification and early outcomes following implementation of a multi-component ambulatory screening program designed to address these system-level barriers. Methods: We conducted a retrospective observational quality improvement analysis across outpatient clinics within a safety-net health system. Pre-implementation data from 2024 assessed smoking history documentation (pack-years and quit date), potential LCS eligibility per U.S. Preventive Services Task Force criteria, and evidence of prior low-dose CT screening. A multi-component ambulatory LCS program was implemented on November 15, 2025, incorporating enhanced tobacco screening workflows, streamlined electronic referrals, patient navigation, and structured follow-up tracking. Post-implementation outcomes included outpatient visits among patients aged 50–80 years, tobacco use screening documentation, and ambulatory referrals to lung cancer screening from November 2025 through January 2026. Outcomes were summarized descriptively. Results: At baseline, 5,563 current or former smokers were seen, of whom 4,903 met age and smoking recency criteria for potential eligibility. Complete smoking history documentation was present in approximately 40% of patients. Based on available documentation, 665 patients met LCS criteria; 512 (77%) had evidence of prior screening or follow-up. Post-implementation, 43,648 outpatient visits occurred, including 23,857 among patients aged 50–80 years. Tobacco use screening was documented in 18,103/23,857 encounters (75.9%). A total of 140 ambulatory referrals to lung cancer screening were placed, increasing from 19 in November to 53 in January. Conclusions: In a safety-net health system, lung cancer screening was limited prior to program implementation by incomplete smoking history documentation and fragmented screening workflows. Early implementation of a multi-component ambulatory screening program incorporating enhanced tobacco screening, streamlined referrals, patient navigation, and follow-up tracking was associated with improved documentation and increased referral activity. Ongoing evaluation will assess screening completion and adherence across the screening program.