1. Suzanne Lenz Wendy Oliver Caitlyn MacGlaflin, Sarah McDougall, Melissa Friedman

2.  Suzanne Lenz and Wendy Oliver have no actual or potential conflict of interest in relation to this program or presentation.

3.  All patients will go through agreed upon process based on USPSTF recommendations.  Informed decision making major part of the process.

4.  Correct exam /correct order  Patients meet all eligibility requirements  All patients participate in informed decision making  Educate referring providers on our process ◦ Provide Clinic Profile and patient education materials  Keep providers informed ◦ Patient “self refers” ◦ Patient’s status within the process  Schedule screening exams in a timely manner

5.  Each screening result is reviewed by coordinator  Referring provider and patient receive results  Patient and provider receive and understand follow-up recommendations  Immediate or near term follow up recommendations are tracked and expedited  Quality measures are obtained

6.  Offer and arrange smoking cessation counseling ◦ For all patients – eligible or not  Inform patients of financial issues  Assist patients without a PCP or insurance  Educate / inform ineligible patients re: low risk  Determine patient interest in future research  Develop and maintain database ◦ Patient data, tracking, quality measures/improvement

7.  33% Coordinator Time ◦ funded through June 30 by Cancer Center  Existing “Resources” Utilized ◦ Interdisciplinary Thoracic Oncology Clinic ◦ CT Surgery ◦ Radiology ◦ Cancer Center

8.  4-Part Process ◦ 7 page word document (text + drop down menus) ◦ Shared on secure folder - Radiology I:Drive  Two “pools” or teams ◦ Screening Access Line (SAL)  3 staff members ◦ Coordinator Pool (CP)  Currently 1 staff member ◦ Communication via eDH In-Basket system

10. SAL CP order query D-H provider Outside provider Patient

11.  Source of Intake to Screening Process 1. eDH Workbench and Image Cast queries: CP  D-H providers  Can “catch” ordered and scheduled exams  Reviewed and routed to SAL 2. Outside or direct provider calls & referrals to SAL 3. Patient inquiry for self or family member to SAL  CP informs / communicates with D-H providers  SAL informs outside providers

12. Part 1 SAL Collect patient / provider / eligibility data Patient educational materials sent Inform providers: self referrals + program process +patient materials + order Part 2 Coordinator Pre Screen Confirm eligibility + medical / imaging history Informed decision making Address patient questions Schedule screening exam Part 2 After Screen Review Results Determine next steps for patient Results to patient + provider Arrange follow-up per provider preference

13. Review statement with patient: “I understand that I am at increased risk to develop lung cancer and may benefit from screening for lung cancer with low-dose chest CT. I also understand that there are both potential benefits and harms to screening. I have had an opportunity to ask questions about the screening process. I agree to be screened with the reports sent to me and to my provider.”

14. Part 3 Coordinator Pool Quality Measures Part 4 Coordinator Final check Immediate / near term follow up arranged All data logged for tracking + patient notifications

16.  Transfer process form to an eDH system  Track patients in eDH ◦ Status during screening process ◦ Follow up after screening  In conjunction with other disciplines, develop Lung Cancer Screening Registry  Process improvement