Implementation of a Centralized Screening Unit at Montefiore-Einstein
Albert Einstein College of Medicine
Summary
This study proposes to increase Lung-cancer screening (LCS) in the Bronx, New York. Despite strong evidence that Lung-cancer screening (LCS) can reduce Lung cancer (LCa) deaths, low-dose computed tomography (LDCT) referral rates by clinicians are very low and there is poor adherence with LCS by patients. Both provider and patient barriers may be amenable to systemic improvements in support, coordination and infrastructure for screening. The investigator team hypothesizes that the implementation of a Central Screening Unit (CSU) that shifts routine workflow attributed to LCS (e.g., collection of smoking history, determination of eligibility, shared decision making and arranging follow-up) away from busy practices (usual care) and that offers patients an array of navigation and support services will increase the uptake of LCS guidelines and subsequent low-dose computed tomography (LDCT) screening scans in a low-income, predominately Hispanic and Black catchment area. The proposed study represents a unique opportunity to test this hypothesis in the context of the roll out of a CSU as a significant new component of the Montefiore-Einstein health system. The investigator team will examine whether and how the CSU facilitates LCS uptake and retention of patients. This study is powered to test whether CSU reduces proportion of late-stage lung cancer diagnoses in the Bronx, New York.
Description
Lung-cancer screening (LCS) reduces lung cancer mortality; however, even with known benefits, LCS uptake has been limited. Barriers to LCS uptake include an absence of full smoking histories in electronic medical records as well as the lack of systems-level infrastructure to routinely identify eligible patients, to contact and navigate those eligible, and to track and support their adherence to serial annual LDCT or follow-up testing/care. Without infrastructure, managing these steps places significant burdens on clinicians and their staff. Interventions to centralize and support workflows to…
Eligibility
- Age range
- 50–77 years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria: Clinic level: * a NYC RING affiliated clinic, * Opt into and agree to research protocol; Patient level: * Age 50-77 for participants, * past or current smoker, * 20+ pack-years tobacco, * has quit smoking within the last 15 years, * without chest CT within the past 12 months, and, * no history of lung cancer or and at least 5 years since the diagnosis of any other malignancy Exclusion Criteria: Clinic level: * only treats pediatric patients, * Opt out of research protocol; Patient level: * Primary care provider instruction to not contact an individual for any reaso…
Interventions
- OtherCentralized Screening Unit Implementation
The CSU provides a proactive and comprehensive population health approach to screening. This includes core functions of a) patient identification, b) contact, c) engagement, education and support, d) referral and navigation to LDCT screening, e) post screening follow-up, and f) retention
Location
- Montefiore Medical Center's New York City Research and Improvement Networking Group (NYC RING)The Bronx, New York