There is a critical need for more effective delivery of intensive tobacco cessation intervention and lung cancer screening with low-dose CT scanning (LDCT) in Central Texas, particularly in underinsured and vulnerable patients. Lung cancer is the most common cause of cancer death in Central Texas. Smoking is the leading cause of preventable mortality and the strongest risk factor for lung cancer. Vulnerable patients ages 50-80 who smoke or recently quit are at particular risk related to uninsuredness and lack of access to evidence-based care. Federally Qualified Health Centers (FQHCs) including CommUnityCare (CUC) and Lone Star Circle of Care (LSCC), serve large numbers of vulnerable...

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There is a critical need for more effective delivery of intensive tobacco cessation intervention and lung cancer screening with low-dose CT scanning (LDCT) in Central Texas, particularly in underinsured and vulnerable patients. Lung cancer is the most common cause of cancer death in Central Texas. Smoking is the leading cause of preventable mortality and the strongest risk factor for lung cancer. Vulnerable patients ages 50-80 who smoke or recently quit are at particular risk related to uninsuredness and lack of access to evidence-based care. Federally Qualified Health Centers (FQHCs) including CommUnityCare (CUC) and Lone Star Circle of Care (LSCC), serve large numbers of vulnerable patients, including (for LSCC) many patients residing in rural and exurban settings with few care resources. Given the expanded eligibility criteria for lung cancer screening in 2021, more people than ever are now considered high risk and eligible for lung cancer screening. However, outside of the current CPRIT program, few patients have access to evidence-based, high quality services for screening or smoking cessation services. We have successfully initiated a lung cancer screening and intensive smoking cessation program in our initial program. Overall Project Strategy: Our goal is to increase access to LDCT scans for high-risk, eligible patients who meet US Preventive Services Task Force (USPSTF) eligibility criteria (age 50-80, 20 pack-year history, currently smoke or quit within last 15 years) and provide comprehensive, evidence-based intensive cessation services (8-12 weeks of individualized counseling support and evidence-based pharmacological intervention) at CUC and LSCC. To increase the number of patients offered and receiving LDCT screening, we have developed partnerships with UT Health Austin, Central Health, and Austin Radiological Associates. CUC, LSCC, and the Dell Medical School will collaborate together to continue to improve the current program, leverage the relationships and expertise that have been established, and create new workflows and opportunities as we expand beyond Travis County, into the surrounding counties through LSCC. We will employ the following evidence-based interventions as appropriate, drawing on our previous experience in multiple health systems serving vulnerable patients: 1) centralized outreach using a well-tested system for assessing eligibility and providing decision support; 2) provider training for "in-reach" (in-office identification and referral); 3) use of a well-tested lung cancer screening patient decision aid developed by our team members to facilitate shared decision making and ensure high-quality decisions; 4) multi-disciplinary collaboration among our project team to ensure high-quality CT interpretation and follow-up; and 5) navigation to promote high adherence and completion of work-ups for abnormal scans. Simultaneously, we will improve access to effective intensive tobacco cessation counseling by: 1) direct outreach to expand reach; 2) additional provider training to improve in-office assessment and motivation; and 3) referral to intensive counseling and enhanced pharmacological therapy. We will offer intensive smoking cessation counseling to 50–80-year-old patients who currently use tobacco. Specific Goals: We aim to increase the number of patients engaged in smoking cessation and anticipate being able to engage 300 patients per year at CUC and LSCC; 20% of those who participate in intensive cessation will successfully quit smoking as measured by 6-month abstinence. We expect to screen about 500 patients annually with LDCT, based on USPSTF guidelines. Navigation for patients requiring follow-up is also a priority, and patients will be supported, referred, and provided resources, particularly those with suspicious LDCT findings. Innovation: Our proposed project is innovative in that it will operationalize, in two safety net systems with diverse and vulnerable patient populations, an expanded, evidence-based, efficient system to identify high-risk, potentially eligible patients for LDCT screening exams; provide patients with brief, well-tested information in a decision aid; and use navigation and intervention to ensure their desired course of action is completed, and ensure that patients who currently smoke have access to intensive, effective smoking cessation counseling. Few primary care systems (and even fewer FQHCs) have successfully implemented such programs nationally. Significance and Impact: Our effort will provide a template of an effective, efficient and scalable system for others who wish to implement LDCT screening and intensive tobacco cessation intervention to reduce lung cancer incidence and mortality in vulnerable safety net clinic populations, particularly other FQHC systems.

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