A Programmatic Approach to Improve Efficiency in Lung Cancer Screening

ABSTRACT

Introduction: Largely as a result of the COVID pandemic, our lung cancer screening (LCS) program was underperforming entering 2021. The program serves a majority minority, socio-economically disadvantaged community. Loss of personnel and reallocated resources, allied to pandemic focus, led to decreased referrals and excessive time from referral to low dose computed tomography (LDCT) appointments. Here we describe our programmatic approach to improve LCS metrics. Methods: LCS transitioned from a Department of Radiology program into a Cancer Center-administered collaborative effort under surgical oncology and radiology leadership. Outreach efforts were reinitiated. To facilitate referrals from our primary care network, the cancer service line created a practical guide, “6 Steps to Lung Cancer Screening”, directly linked to an e-referral mechanism in our EMR. Monthly review and quality assurance meetings were held with a multidisciplinary team, specifically focused on program volume and on addressing delays to LDCT appointments. An additional Nurse Practitioner was brought in to enhance the existing LCS Nurse Navigator and Cancer Center staff were utilized to contact and schedule patients and to perform data compilation and analysis. Results: In 2020, LCS referrals had decreased 13% from 2019. In Q1/2021, the median monthly number of LCS referrals was 132 which increased steadily by quarter to 218 in Q4/2021 (p=0.16, Figure 1A). In January 2021, the average time from LCS referral to LDCT appointment was 101 days. Despite the increasing number of referrals through 2021, we were able to decrease the time to appointment from a median of 86 days in Q1/2021 to a median of 29 days in Q4/2021 (p=0.02, Figure 1B). By December 2021, the average time from LCS referral to LDCT appointment was just 18 days. Our LCS referral population was predominantly non-white (76%). Among them, 7.4% of patients with LDCT scans were found to have Lung RADS 3 or 4 nodules. All of these patients were referred to a newly created high-risk lung nodule clinic for management and follow up. Conclusions: We employed a multidisciplinary team approach to improve inefficiencies in our LCS program. The resources, support, and leadership of the health care system’s Cancer Center were crucial to this multi-pronged initiative. The decreased time from LCS referral to LDCT facilitates our ability to handle the anticipated growth in referral volume. This has been shown to enhance engagement with LCS and to improved annual screening compliance, translating to earlier detection of lung cancer and to improved patient outcomes. [Formula presented] Keywords Lung cancer screening, Adherence, Disparity