Engaging patients in lung cancer screening is challenging, and nationally rates remain incredibly low. A recent study found only an estimated 14% of eligible patients received the recommended screening exam. Patients are often referred by their primary care physicians (PCPs), who play an incredibly important role in driving volume for lung cancer screening programs. But PCPs are notoriously busy, and it falls to lung cancer screening programs to ensure providers are well equipped to discuss lung cancer screening with their patients.

Wellstar’s goal is to make it as easy as possible for PCPs to refer patients into lung cancer screening programs. To do this they focus on two areas:

1. Provide practical, useful education to PCPs

Wellstar leverages their physician relations team and nurse navigators to educate PCPs in their market. They focus on providing only the most critical information, such as:

• The burden of undiagnosed lung cancer in their practice, including smoking rates and lung cancer prevalence in the area
• How to record an accurate smoking history, which is required to determine patient eligibility but challenging to providers to accurately track

2. Create a seamless referral experience

To assist providers in qualifying and referring patients for lung cancer screening, Wellstar developed a shared decision-making tool for clinicians and clinician assistants within their electronic health record (EHR) that pulls patient’s age and smoking history to determine eligibility. For eligible patients, a best practice recommendation appears that includes a short script for providers, which may serve as the shared-decision-making visit, and one-click referral for screening. Wellstar’s lung cancer screening program takes ownership of all patient follow-up, again reducing burdens on PCPs.

What are incidental pulmonary nodules (IPNs)?

Incidental findings are abnormalities uncovered unintentionally and unrelated to the condition that prompted an exam. Pulmonary nodules are abnormal growths that form in a lung. They can be identified on imagining scans. Most pulmonary nodules are benign, but some indicate the presence of lung cancer.

IPNs are key to a comprehensive lung cancer program

Wellstar expanded their lung cancer detection program in 2020 to more formally focus on incidental pulmonary nodule management in addition to LDCT screening. The organization invested in a tool embedded in their EHR to provide a database and tracking tool for patients with IPNs detected at Wellstar. The tool is primarily used by Wellstar’s lung navigators to longitudinally track patients and coordinate recommended follow-up care.

In the first 12 months of their IPN program Wellstar detected and treated 36 lung cancers. Wellstar expects to rescan 6,000 patients in 2022 that originally entered the lung cancer detection program with IPNs (compared to 7,000 from screening).

If managed correctly, incidental findings may allow more patients with lung cancer to be diagnosed at earlier stages, providing another opportunity to help improve survival.

The hallmark of Wellstar’s lung cancer detection program is their approach to reduce time from screening to treatment. Instead of fitting the patient into the clinician workflow, Wellstar built a workflow around the patient. They call this a synchronous, patient-centric approach internally branded as “STAT Clinics.”

To implement this new vision, Wellstar made two operational changes:

1. Centralized all services and clinicians involved in lung cancer detection, staging, and treatment decisions.

2. Established two 7-day cycles with goals and processes for each, holding clinicians to an established timeline.

Program success relies on strong patient navigators to support patients and facilitate clinician decision making.

STAT Clinic Cycles

Navigators initiate both 7-day cycles, which begin with multidisciplinary consensus (MDC) meetings. Throughout these cycles navigators also provide additional administrative support, such as obtaining insurance authorizations.

Importantly, multidisciplinary consensus meetings occur while the patient is in the clinic. This allows patients to leave each appointment with results and next-steps in hand.

Wellstar continues to iterate with process improvements that will cut time to diagnosis and move patients to treatment faster. The STAT Clinic approach has allowed Wellstar to improve survival rates, improve patient satisfaction, and reduce unnecessary testing and visits (reducing total cost).