IMPLEMENTATION OF LUNG CANCER SCREENING IN A RESIDENT CLINIC AT THE VETERANS AFFAIRS AUSTIN OUTPATIENT CLINIC (AOPC)

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: The delivery of preventive healthcare services remains low despite evidence for its effectiveness. The USPSTF recommends adults age 55-80 with a 30 pack year history of smoking be screened with a low-dose CT (LDCT) scan for lung cancer, if they quit within the last 15 years. Unfortunately, preventative screening can be neglected due to time constraints and urgent medical problems faced by physicians in the outpatient clinic. We propose a patient-facing lung cancer screening questionnaire to improve screening rates without increasing burden on the primary care physician (PCP). METHODS: We designed a smoking history questionnaire for patients to complete before being seen by their PCP at an outpatient Veterans Affair (VA) clinic. The questionnaire determines if the patient qualifies for LDCT screening based on their age and smoking history. The completed questionnaire was given to the physician during the visit to identify patients eligible for screening, and physicians were encouraged to discuss appropriate screening with the patient and order a LDCT if indicated. We tracked completion of the questionnaires, offers of screening to patients, and orders placed for LDCT. We used McNemar’s test to compare the proportion of patients that received an offer for screening before and after using the questionnaire. RESULTS: From January 1 2019 to February 28 2019, all 334 patients with clinic appointments completed a questionnaire and 65 (19.5%) were eligible for screening. A total of 49 (75.4%) of these patients were offered LDCT screening, and 45 (92%) accepted and had an order for a LDCT entered into the electronic health record (EHR). Retrospective chart review of the 65 eligible patients showed that 16 (24.8%) had a LDCT in 2018 and 23 were ever offered LDCT screening previously (35.4%). The proportion of patients offered LDCT screening was significantly higher after implementing the questionnaire (23/65 before questionnaire vs 49/65 after, P<0.001). CONCLUSIONS: Our simple paper questionnaire assessing for smoking history allowed us to significantly increase the proportion of VA clinic patients that received appropriate lung cancer screening. While a patient’s acute problem may take priority at clinic visits, inadequate screening puts patients at risk for undiagnosed lung cancer. Implementation of this questionnaire enabled the discussion of lung cancer screening to take place, even in the face of a busy clinic appointment. CLINICAL IMPLICATIONS: A simple approach to lung cancer screening can help facilitate higher screening rates while avoiding additional time burden placed on PCPs. DISCLOSURES: No relevant relationships by Kaveeta Marwaha, source=Web Response No relevant relationships by Asma Nuri, source=Web Response No relevant relationships by Zachary Pinchover, source=Web Response No relevant relationships by Mohi Syed, source=Web Response No relevant relationships by Sarah Taunton, source=Web Response No relevant relationships by Victoria Valencia, source=Web Response