Until 2017, University of Iowa Health Care had no coordinated referral program in place for proactively screening eligible patients for lung cancer. That year Sara Kraus, ARNP, DNP, FNP-BC, and Kim Baker El-Abiad, MD, both from the Department of Internal Medicine’s Division of Pulmonary, Critical Care, and Occupational Medicine, set out to change that. The duo and their steering committee developed a centralized screening program to promote accessibility and improve continuity of care across disciplines at every stage of the screening process. Their goal then and now is to increase patient adherence to annual and interval low dose computed tomography (CT) scans for lung cancer in order to detect the disease at an earlier stage.
The screening team’s combined efforts have significantly increased patient return rates for annual scans. The national average for patient return rates for annual lung cancer screening scans is around 25–30%. After the program implementation, UI Health Care’s return rate is close to 70%. This number indicates the process has been working: Iowans are being appropriately screened, and providers are correctly identifying lung issues at a much higher rate than in other states. The new process has improved access to screening and decreased follow-up time for patients who have abnormal findings.
Most insurance will cover lung cancer screenings if an individual meets certain criteria, including that they must be between the ages of 50 and 77, and are a current or former cigarette smoker, having quit within the last 15 years, with a history of at least 20 “pack years,” defined as having smoked the equivalent of at least one pack of cigarettes a day for the last two decades.
Scans can create anxiety for patients and for clinicians. Some health care professionals who are ordering lung cancer screening CTs for their patients may appreciate guidance with the management of the results. This is where Kraus and Baker El-Abiad come in: they help facilitate follow-up of abnormal results, which builds confidence in treatment plan coordination in their colleagues, as they are assured the right eyes are on the scans at the right times.
“There’s a high percentage of incidental findings that have nothing to do with lung cancer or lung cancer screening, and anything on the CT that’s abnormal will be reported by the radiologist. It’s really important to make sure we have our partners in primary care available to help us with this piece. In turn, we help them with abnormal lung cancer screening findings in the lung and make sure that we are available if they have questions,” Kraus said.
The process has evolved since its original implementation in 2018, including the integral addition of Lung Cancer Screening Specialist, Mindy Coghlan, LPN, BS. Coghlan acts as a liaison between referring providers and their patients, offering services like initiating shared decision making visits with patients, personally following up with patients to schedule ongoing screenings, and working with clinicians across the hospital to create a transparent care plan for shared patients.
Additionally, Coghlan, Kraus, and Baker El-Abiad have access to a Lung Screening Dashboard in Epic, which Cass Garrett, Senior Application Developer for the Epic Radiant Team, specifically designed to complement the process the committee formed. This dashboard tracks data submitted to the American College of Radiology’s Lung Cancer Screening Registry and tracks UI Health Care patients in the lung cancer screening program. Garrett also took questions that Kraus and Baker El-Abiad began asking regularly throughout the process development, like which patients are approaching the top age limit for screenings, and created reports to incorporate into the dashboard for quick access to answers.
Not resting on the program’s achievements, it continues to grow and refine. Internal education on when and how often clinicians should suggest screenings to their patients will increase the prevalence of screenings, as will having ongoing discussions about shared decision making with patients. In January 2024, an informational website geared toward patients was launched, helping to educate the prospective patients on the importance of lung cancer screenings and what to expect.
“It’s constantly evolving,” Baker El-Abiad said. “Inevitably there are new questions or new issues that come up with lung cancer screening and how we can we improve it. How can we make it easier for patients or for providers right now?”
More recently, the program has evolved to a hybrid program wherein providers can take ownership of the whole screening process or continue to refer to the program. Either way, patients being screened are tracked with “whole person care” in mind.
Kraus and Baker El-Abiad want to acknowledge the group who continue to make this program possible:
- Mindy Coghlan, LPB, BS, Lung Cancer Screening Specialist
- Keith Burrell, Enterprise Reporting Architect
- Cass Garrett, Senior Application Developer
- Partners at Epic
- Internal Medicine leadership
- Iowa River Landing leadership
- Department of Radiology
- Holden Comprehensive Cancer Center
- Lung Cancer Screening steering committee