Embedding USPSTF lung cancer screening guidelines within an EMR SmartSet increased screening rates among eligible tobacco users from 52% to 63% (OR 1.67; 95% CI 1.49-1.88).
Does an EMR reminder and resident education improve lung cancer screening rates in eligible tobacco users?
Integrating point-of-care EMR prompts and resident education is an effective strategy to increase adherence to lung cancer screening guidelines among high-risk tobacco users.
Estimación del efecto: OR 1.67 (95% CI 1.49-1.88)
Tasa de eventos absoluta: 63% vs 52%
e23286 Background: Lung cancer has been the leading cause of cancer death in the United States for over 70 years. Approximately 85-90% of patients with lung cancer are current or former tobacco users. The guideline for lung cancer screening is unique in that it is correlated to a preventable risk factor: tobacco use. Since March 2021, the United States Preventive Service Task Force (USPSTF) has recommended lung cancer screening for adults 50-80 years with at least a 20-pack-year smoking history who currently smoke or have quit within 15 years. Our quality improvement project was designed to increase screening in tobacco users in East Texas, thereby increasing patients who are appropriately screened for lung cancer. Methods: Our residency clinic at CHRISTUS Health in Longview, TX uses EPIC as its electronic medical record (EMR), which includes SmartSets that combine orders to streamline patient care. We added a reminder on the “Tobacco/E-cig/Vaping Cessation” SmartSet to use the “Lung Cancer Screening” SmartSet to order low-dose CT scans based on USPSTF criteria. Residents were educated about the updates and importance of utilizing both SmartSets in February 2025. Baseline differences (Table 1) were assessed using two proportion z tests, comparing our clinic (Long Resident Clinic) to other CHRISTUS clinics over one year. We used a generalized linear mixed model (GLMM) since screening practices may vary across clinics. We hypothesized an increase in screening by at least 5% by the end of 2025. Results: Our clinic’s baseline screening rate was 52%, compared with 41.7-44.6% at other clinics with differences statistically significant across all clinics (p < 0.03, BH-adjusted p < 0.05). Screening rates at our clinic increased, reaching 63% by December 2025; the GLMM showed a statistically significant positive time effect. The intervention was associated with higher screening odds (OR=1.67, 95% CI: 1.49-1.88). Conclusions: Embedding the USPSTF guidelines within the SmartSet increased appropriate low-dose CT screening by identifying tobacco users and adherence to screening criteria. Furthermore, our findings support integrating point-of-care EMR prompts as an effective strategy to close screening gaps, standardize evidence-based practice, and facilitate early detection of lung cancer in vulnerable populations. This strategy can be used among high risk patients across health systems to positively impact morbidity and mortality. Baseline two sample tests of proportions (Long Resident Clinic vs other regional clinics). Comparison clinic LRC rate 1 Other rate Diff. (pp) 2 p-value BH-adjusted p 3 Long Internal Medicine 0.520 0.430 9.0 0.0177 0.0237 Longview/Marshall Primary Care 0.520 0.446 7.4 0.0253 0.0253 CTC Primary Care 0.520 0.443 7.7 0.0152 0.0237 SPN Fam Med Academic 0.520 0.417 10.3 0.0110 0.0237 1 Long Resident Clinic. 2 Difference in percentage points. 3 p-values adjusted using the Benjamini–Hochberg method.
Singh et al. (Thu,) conducted a other in Lung cancer screening. EMR SmartSet reminder for lung cancer screening vs. Baseline screening practices was evaluated on Lung cancer screening rate (OR 1.67, 95% CI 1.49-1.88). Embedding USPSTF lung cancer screening guidelines within an EMR SmartSet increased screening rates among eligible tobacco users from 52% to 63% (OR 1.67; 95% CI 1.49-1.88).