Implementation of a guideline-aligned lung cancer screening questionnaire in a resident run internal medicine clinic.

Abstract

46 Background: Lung cancer remains the leading cause of cancer-related mortality in the United States, and low-dose CT (LDCT) screening reduces lung cancer mortality. Despite USPSTF recommendations for annual LDCT in adults aged 50–80 years with ≥20 pack-years who currently smoke or quit within 15 years, screening uptake remains low in primary care. In resident-run clinics, inconsistent smoking history documentation and lack of systematic prompts may contribute to missed screening opportunities. We implemented a patient-facing, USPSTF-aligned intake questionnaire with the aim of increasing encounters with sufficient structured smoking history documentation to determine USPSTF eligibility to 50% within 6 months. This interim analysis evaluates early post-implementation outcomes. Methods: We conducted an interim pre/post quality improvement analysis of de-identified encounters for patients aged 50–80 seen in a resident-run internal medicine clinic. The pre-intervention period was Jan–Mar 2026. The early post-intervention period was May to early June 2026 after implementation of a nurse-administered smoking history questionnaire. Outcomes included structured documentation of tobacco-related variables, ability to classify USPSTF eligibility, and LDCT screening orders. Results: There were 150 pre-intervention and 99 post-intervention encounters. Tobacco type documentation increased from 57.3% to 69.7% (+12.4 percentage points), cigarettes/day from 10.7% to 17.2% (+6.5), years smoked from 7.3% to 12.1% (+4.8), and age started smoking from 4.7% to 12.1% (+7.5). Pack-year documentation remained low (3.3% vs 4.0%), as did sufficient structured data to classify USPSTF eligibility (10.0% vs 14.1%). LDCT ordering was unchanged (3.3% vs 3.0%). Conclusions: In this 6-week interim analysis, a patient-facing questionnaire modestly improved documentation of selected tobacco-history variables but did not meaningfully improve complete USPSTF eligibility classification or LDCT ordering. Early implementation gaps included inconsistent conversion of questionnaire responses into structured EMR data and dependence on resident review during visits with competing priorities. Next steps include targeted education of triage personnel, resident re-education regarding documentation and screening deficiencies, physical reminders to prompt completion of key tobacco-history fields, and development of structured EMR prompts to support eligibility assessment.