School of Medicine and Health Sciences Poster Presentations

Title

Challenges to Lung Cancer Screening: Increasing Screening In Ambulatory Setting

Poster Number

316

Document Type

Poster

Status

Medical Resident

Abstract Category

Quality Improvement

Keywords

lung, cancer, screening, ambulatory, care

Publication Date

Spring 2018

Abstract

Lung cancer remains the leading cause of malignancy related death in the United States. A significant component of this mortality is late diagnosis and recognition as earlier diagnosis offers more definitive treatment options. .There is evidence that early detection of lung cancer by screening high risk patients with annual low-dose CT scans can improve the survival rate by 20%, and is now recommended by the USPSTF. However, low dose CTs are not ordered by primary care physicians as routinely as other screening tests such as mammography. Previously, in the resident clinic at the Medical Faculty Associates at George Washington University Hospital, only 4.3% of physicians documented whether or not a patient met criteria for lung cancer screening. Documentation and ordering of the exams remained low despite re-education about recommendations and making the ordering process simpler. The year prior, our colleagues surveyed attending physician, which showed multiple reasons that added to the low rate of screening. A few of the core reasons for poor documentation and ordering, including lack of knowledge of the guidelines, obtaining insufficient smoking history, and poor documentation and ordering habits. With this data we undertook a quality improvement project to compare ordering of low dose CT scans for screening before and after direct email messaging with information on proper screening and directions on how to order. In addition, we compared appropriate documentation of those that both qualified or did not qualify for screening process at annual physical exams before and after the designated targeted interventions. Targeted interventions included email prior to the start of the residents outpatient ambulatory week and direct communication with printed-out material. Our aim was to increase the rate of residents documentation of both qualifying and non-qualifying screening of patients, and appropriate ordering of low-dose CT scans, by 25% after initiation after each targeted interventions. Further strategies include finding barriers that caused poor gathering of smoking history, quicker or more efficient EMR documentation techniques, and continued education of current evidence based practices.

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Challenges to Lung Cancer Screening: Increasing Screening In Ambulatory Setting

Lung cancer remains the leading cause of malignancy related death in the United States. A significant component of this mortality is late diagnosis and recognition as earlier diagnosis offers more definitive treatment options. .There is evidence that early detection of lung cancer by screening high risk patients with annual low-dose CT scans can improve the survival rate by 20%, and is now recommended by the USPSTF. However, low dose CTs are not ordered by primary care physicians as routinely as other screening tests such as mammography. Previously, in the resident clinic at the Medical Faculty Associates at George Washington University Hospital, only 4.3% of physicians documented whether or not a patient met criteria for lung cancer screening. Documentation and ordering of the exams remained low despite re-education about recommendations and making the ordering process simpler. The year prior, our colleagues surveyed attending physician, which showed multiple reasons that added to the low rate of screening. A few of the core reasons for poor documentation and ordering, including lack of knowledge of the guidelines, obtaining insufficient smoking history, and poor documentation and ordering habits. With this data we undertook a quality improvement project to compare ordering of low dose CT scans for screening before and after direct email messaging with information on proper screening and directions on how to order. In addition, we compared appropriate documentation of those that both qualified or did not qualify for screening process at annual physical exams before and after the designated targeted interventions. Targeted interventions included email prior to the start of the residents outpatient ambulatory week and direct communication with printed-out material. Our aim was to increase the rate of residents documentation of both qualifying and non-qualifying screening of patients, and appropriate ordering of low-dose CT scans, by 25% after initiation after each targeted interventions. Further strategies include finding barriers that caused poor gathering of smoking history, quicker or more efficient EMR documentation techniques, and continued education of current evidence based practices.