Population Health Management Approaches to Increase Lung Cancer Screening in Community Health Centers

Lung cancer is the leading cause of cancer-related mortality in the U.S., accounting for approximately 1 in 5

cancer-related deaths. Approximately 80% of lung cancers are attributable to cigarette smoking. Annual Low-

Dose Computed Tomography screening for lung cancer (hereafter referred to as Lung Cancer Screening or LCS)

is recommended by the U.S. Preventive Services Task Force (USPSTF). Despite evidence of effectiveness and

the USPSTF recommendations, implementation of LCS into clinical practice has been exceedingly limited, with

only 6.5% of eligible individuals screened in 2020, and there are major health inequities in LCS related to

race/ethnicity and socioeconomic status. The long-term goal of this program of research is to increase the

reach of LCS at scale among low resource healthcare settings and populations that have been historically

marginalized. The proposed project, LungSMART Utah, is a two phase, Sequential Multiple Assignment

Randomized Trial (SMART) conducted in Utah Community Health Centers (CHCs). Utah has 14 CHC systems

with 50 primary care clinics. Each of the Utah CHCs are Federally Qualified Health Centers, providing

comprehensive primary care to >160,000 patients annually. Utah CHC patients are: 50% Latino, 8% Native

American, 38% best served in a language other than English, 61%4). LungSMART Utah is guided by a

comprehensive conceptual framework and is designed to directly address LCS implementation challenges to

ensure equitable implementation and reduce health inequities. LungSMART Utah utilizes a Population Health

Management (PHM) framework, in which scalable, accessible, and sustainable telehealth interventions are

used to engage patients in LCS. Phase 1 of the SMART leverages ubiquitous technologies to enable CHC

patients to be assessed for LCS eligibility, engage in Shared Decision Making (SDM) if eligible, and be referred

for LCS. Phase 2 of the SMART tests telehealth interventions designed to address logistical barriers and

hesitancy around completing LCS among referred patients. LungSMART Utah leverages smartphone/internet

technologies when available, and also supports patients whose only telehealth connectivity is a cellphone. A

centralized “Hub” enables eligibility assessment, SDM with clinical decision support, screening referral, and

screening logistics assistance at scale to help overcome numerous social determinants of health that impact low

resource settings and historically marginalized populations. All study procedures and interventions will be

conducted in English or Spanish based on the patient's preferred language. In sum, LungSMART Utah will be

conducted in a real-world context across multiple, independent healthcare delivery systems with limited

resources (i.e., CHCs) and among historically marginalized populations (i.e., low SES, rural, Latino).

LungSMART Utah will provide a critical evidence-base for the large-scale implementation of interventions

designed to reduce health inequities in LCS at CHCs and other low resource settings nationwide.