P2.11-27 A Rapid Access Lung Cancer Clinic Reduces Variation in Lung Cancer Diagnostic and Treatment Services.

Abstract

the experience in clinical trials. Method: We purposefully employed a soft-launch of our lung cancer screening program with low-dose CT (LDCT) so we could rapidly evaluate our experience through audit and feedback. The program began in January 2015 and included several key implementation components: 1) guideline review supporting lung cancer screening; 2) continuing medical education to physicians regarding implementation; 3) Epic-registry build to account for eligible members, orders for LDCT, completion of LDCT, and radiologic results; 4) Nurse care coordinator to follow-up with screen positive members to return for imaging; 5) Development of a shared decision making tool for patient/provider discussions. LDCT is read by radiologists using American College of Radiology Lung-RADS TM grading system. We describe the uptake of LDCT in an age-and smoking-eligible population and alignment of Lung-RADS TM with expected population estimates overall among exams conducted from 2015-2018. Negative screen is defined as Lung-RADS TM 1 or 2. Positive screen includes Lung-RADS TM 3 and 4. Result: With an estimated 15,000 adults eligible for lung cancer screening, about 1,800 annual visits have a documented shared decision-making. While the majority of patients (89%) opt-in to screening, about 26% of those patients cancel or do not show up for their LDCT exam. As of March 2018, KPWA completed 3,092 LDCT exams: 2,104 initial screens and 988 subsequent screens. Among all initial LDCT performed, 84.6% screened negative; the proportion increased slightly to 88.6% on subsequent LDCT exams. On initial LDCT, the proportion of positive exams were as follows: Lung-RADS TM 3 (7.8%); Lung-RADS TM 4A (3.3%), and Lung-RADS TM 4B, C, X (2.4%). On subsequent LDCT exams, these proportion decreased slightly to 5.2% and 2.2% for Lung-RADS TM 3 and 4A, respectively. Conclusion: Overall implementation of KPWA lung cancer screening suggests an ability to identify eligible patients, engage in shared decision-making, appropriate referral and uptake of LDCT, appropriate use of Lung-RADS TM assessment, and patients who return for follow-up and subsequent annual screening. Opportunities remain for improvement in acceptance of LDCT based on patient needs and further adoption within our system.