Lung cancer is the leading cause of cancer deaths. Over 50% of patients are diagnosed at an advanced stage, corresponding to a 5-year survival of less than 20%, compared to 56% for early stages. Thus, early identification and screening high risk individuals is vital. Lung cancer screening with low dose computed tomography (LDCT) was introduced in 2013 and updated in 2021. Current guidelines recommend annual LDCT screening in adults aged 50 to 80 who have a 20 pack-year or more smoking history and are current smokers or quit in the last 15 years. In 2015, the National Health Interview Survey showed only 3.9% underwent screening. The underutilization of LDCT is seen nationwide, however, Georgia is ranked poorly amongst other states. The primary barriers identified in literature include failure of electronic medical records (EMR) to notify providers of eligible patients, concerns of high false positive rates, lack of insurance coverage, patient refusal and lack of awareness.
By addressing these barriers, the purpose of this quality improvement project was to improve lung cancer screening in primary care resident clinics at a tertiary medical center in northeast Georgia from June to December 2022. This project was extrapolated to the institution across all primary care clinics. In the resident clinics, the goal was to increase LDCTs rates by 100%, or from an average of 8 to 16 monthly. For institutional clinics, the goal was to increase LDCTs rates by at least 50%, or from an average of 28 to 42 weekly.
We used a multi-modal approach of educational patient flyers, provider reference guides, and community outreach events. We also improved EMR documentation of smoking history by participating in the nationwide Just Ask campaign. Patient flyers included current guidelines and a QR code to determine eligibility. Provider reference guides highlighted updated guidelines, billing, and coding for LDCT scans. Community events included local radio show interviews with ongoing plans to disseminate information via social media platforms. After five months of implementation, average LDCTs increased to 23 monthly in resident clinics and to 39 weekly in institutional clinics. The results thus far are promising and have shown increased screening rates within our community. Through the implementation of our current and upcoming interventions, we hope to see an overall success in both resident and institutional clinics upon the completion of this project.