Assessing Adherence of Smoking History Documentation to Improve Lung Cancer Screening

Abstract

Problem: The United States Preventive Services Task Force (USPSTF) recommends annual lung cancer screening with low dose computed tomography (LDCT) for eligible patients. A detailed smoking history informs clinical decision making regarding the recommendation to pursue LDCT. In March 2023, a random chart audit in a rural primary care center revealed a detailed smoking history was missing on 82% of all patients and an evidence-based decision regarding LDCT was missing for 100% of patients. Purpose: This quality improvement (QI) project aims to optimize smoking history documentation, increasing referral for LDCT in order to screen for lung cancer and refer for management. Methods: Prior to project implementation, an interdisciplinary team of stakeholders at the practice site including a physician and six office staff members was mobilized and educated on the proposed practice change including integration of a smoking history data collection tool (SHDCT), establishment of a referral process for appropriate patients, and creation of a follow up procedure for specialist referral. Office staff provides each patient with the SHDCT to complete privately in the waiting room; an estimated 500 patients will complete the SHDCT during the 15-week implementation. The provider then reviews the SHDCT with the patient, determines screening eligibility, and orders LDCT if indicated. Following the encounter, office staff scans SHDCT into the electronic health record and schedules LDCT for suitable patients. After LDCT is obtained, provider reviews the results and refers screening-positive patients to a specialist. Results: Of the 438 patients seen during implementation, 87.7% of patients now have completed SHDCTs documented in the EHR. Of the 54 patients qualified for LDCT, 72.2% have LDCT ordered. Of the ordered LDCTs, 45% are complete by the end of the 15-week implementation. No patients required specialist referral based on LDCT findings. Conclusions: Results reveal the intervention has promoted best Problem: The United States Preventive Services Task Force (USPSTF) recommends annual lung cancer screening with low dose computed tomography (LDCT) for eligible patients. A detailed smoking history informs clinical decision making regarding the recommendation to pursue LDCT. In March 2023, a random chart audit in a rural primary care center revealed a detailed smoking history was missing on 82% of all patients and an evidence-based decision regarding LDCT was missing for 100% of patients. Purpose: This quality improvement (QI) project aims to optimize smoking history documentation, increasing referral for LDCT in order to screen for lung cancer and refer for management. Methods: Prior to project implementation, an interdisciplinary team of stakeholders at the practice site including a physician and six office staff members was mobilized and educated on the proposed practice change including integration of a smoking history data collection tool (SHDCT), establishment of a referral process for appropriate patients, and creation of a follow up procedure for specialist referral. Office staff provides each patient with the SHDCT to complete privately in the waiting room; an estimated 500 patients will complete the SHDCT during the 15-week implementation. The provider then reviews the SHDCT with the patient, determines screening eligibility, and orders LDCT if indicated. Following the encounter, office staff scans SHDCT into the electronic health record and schedules LDCT for suitable patients. After LDCT is obtained, provider reviews the results and refers screening-positive patients to a specialist. Results: Of the 438 patients seen during implementation, 87.7% of patients now have completed SHDCTs documented in the EHR. Of the 54 patients qualified for LDCT, 72.2% have LDCT ordered. Of the ordered LDCTs, 45% are complete by the end of the 15-week implementation. No patients required specialist referral based on LDCT findings. Conclusions: Results reveal the intervention has promoted best