Need: 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 Travis County, particularly in underinsured and vulnerable patients. Lung cancer is the most common cause of cancer death in Travis County, accounting for 20% of all cancer deaths in 2017. Smoking is the leading cause of preventable mortality and the strongest risk factor for lung cancer. The vulnerable patients served in Travis County’s main safety net care system, CommUnityCare Health Centers (CUC), are particularly at risk: 50% of patients ages 55-77 are former or current smokers. Of these more than 7,000 patients, over 3,00...

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Need: 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 Travis County, particularly in underinsured and vulnerable patients. Lung cancer is the most common cause of cancer death in Travis County, accounting for 20% of all cancer deaths in 2017. Smoking is the leading cause of preventable mortality and the strongest risk factor for lung cancer. The vulnerable patients served in Travis County’s main safety net care system, CommUnityCare Health Centers (CUC), are particularly at risk: 50% of patients ages 55-77 are former or current smokers. Of these more than 7,000 patients, over 3,000 are current smokers and over 1,000 are former heavy smokers (over 30 pack years of exposure). As such, over 4,000 patients in the CUC system are potentially eligible for smoking cessation interventions and/or lung cancer screening. However, few CUC patients have had access to evidence-based, high-quality care: currently, potentially eligible patients ages 55-77 are not assessed for screening eligibility or offered screening, and CUC does not offer intensive smoking cessation intervention. Overall Project Strategy: Our goal is to increase access to LDCT scans for current and former smokers ages 55-77 at CUC who meet U.S. Preventive Services Task Force (USPSTF) eligibility criteria and provide comprehensive, evidence-based intensive cessation services (8-12 weeks of counseling support and pharmacological intervention) to current smokers. To increase the number of patients offered and receiving LDCT screening, we have formed a strong partnership among The University of Texas at Austin (UT Austin), CommUnity Care, and the Community Care Collaborative (CCC). We will employ the following evidence-based interventions, 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 and decision support for “in-reach” (in-office identification and referral); 3) use of a well-tested patient decision aid developed by our team members; 4) nurse-led shared-decision making visits to ensure high quality decisions; 5) multi-disciplinary collaboration among our project team to ensure high-quality CT interpretation and follow-up; and 6) nurse-led navigation to promote high adherence and completion. Simultaneously, we will improve access to effective intensive tobacco cessation counseling by: 1) mailed and electronic outreach to expand reach; 2) additional provider training to improve in-office assessment and motivation; and 3) referral to nurse-led intensive counseling (phone and in-person group) and enhanced pharmacological therapy. Over the course of 3 years, we will assess screening and cessation service eligibility through centralized outreach and clinic in-reach of all approximately 7,500 age-eligible current and former smokers. We anticipate that approximately 2,000-2,500 will be found to be eligible for LDCT screening. Based on the previous literature and our previous outreach program in colon cancer screening, we anticipate that approximately 400-600 will accept the invitation and decide to have LDCT at least once. We will offer intensive smoking cessation service referral to all 3,000+ current tobacco users ages 55-77, few to none of which currently have access to intensive interventions. We anticipate that 10-20% (up to 600) of those eligible will agree to participate in an intensive intervention; over the course of the program, and that 15-20% of those who participate in intensive cessation will successfully quit smoking as measured by 6-month abstinence, leading to an additional 100-150 people who quit smoking as a result of our program. Innovation: Our proposed project is innovative in that it will operationalize, in a safety net system with a diverse and vulnerable patient population, an evidence-based, efficient system to identify current and former smokers potentially eligible for LDCT screening exams; provide them with brief, well-tested information in a decision aid; and use nurse-navigation and a nurse-led intervention to ensure their desired course of action is completed and that current smokers have access to intensive smoking cessation therapy. It is also innovative in that such an approach has not, to our knowledge, been implemented in a highly vulnerable, Latino-predominant population by a bilingual care team, and builds on our previous success in colon cancer screening. 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, highly Latino safety net clinic populations.

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