Background: Lung cancer is the leading cause of death in men and women in the United States, with an estimated 228,150 new cases diagnosed, and 142,670 deaths. Memorial Hermann Health System (MHHS) implemented a low-dose computed tomography (LDCT) screening program in 2015 aimed at improving the early detection of lung cancers in high-risk patients. The LDCT program is based on the US Preventive Services Task Force (USPSTF) recommendations for lung cancer screening. Program information was provided to patients and providers within the community utilizing the MHHS website and community events. Currently, 22 MHHS sites provide LDCT screenings for patients across the Houston area, with a total of 3803 screens performed and 36 lung cancers found since the inception of the program. Program growth is evident by a 400% increase of screened patients comparing year 1 with year 4 volumes, with a projected 2000 patients to be screened in FY2019. An assessment of the program was conducted by the MHHS cancer registry and nurse navigation team to identify barriers in follow-up of patients with abnormal LDCT findings. Based on this assessment, it was determined a process improvement plan was needed to improve patient follow-up and outcomes.
Objectives: Develop a process improvement action plan to increase compliance in follow-up for LDCT patients with Lung Rad (LR) 4, using nurse navigators to provide continuity of care and assessment of barriers to follow-up.Methods: Retrospective data for LDCT lung screenings, and a quantitative review of radiologist recommendations per American College of Radiology (ACR) standards, resulting in LR 4 for FY2015 through FY2018 of the program was completed by the nurse navigator and cancer registry teams. Publications demonstrating increased patient compliance in care within programs involving nurse navigation were reviewed. Implementation of a daily LR 4 report (4A, 4B, 4X) per radiologist findings was developed and distributed to nurse navigators to address receipt of report and discussion of results with providers, and to assess barriers to follow-up for patients screened.
Results: Data review of LR 4 (4A, 4B, and 4X categories) results from FY2015 through FY2018 revealed noncompliance or no return for follow-up per radiologist recommendations based on ACR standards for LDCT lung cancer screening in 24% of LR 4A, 22% of LR 4B, and 12% of LR 4X patients screened. Of the total patients within the same period for each category, 3/166 LR 4A, 16/105 LR 4B, and 17/43 LR 4X patients were found positive for malignancy upon further imaging and testing, per ACR recommendations.
Conclusion: Implementation of an LDCT lung screening program at MHHS and continued education for patients and providers have increased knowledge of the USPSTF screening recommendations for high-risk patients using LDCT lung screening. Success of the program can be measured by the increase in volume of high-risk patients screened since the inception of the program. To improve patient outcomes for early lung cancer detection, nurse navigators must continue to follow up and assess patients with LR 4 results, per ACR recommendations. In doing so, nurse navigators can identify barriers and implement any assistance necessary for follow-up care.
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