Need: Evidence-based interventions to effectively decrease preventable disease, disability and death caused by tobacco use are much needed in Tarrant and its surrounding counties. As within the original service area, 15% of age-eligible residents are estimated to be active smokers in the proposed expansion region. The expansion region also maintains higher rates for both lung cancer incidence and mortality, as compared to the state of Texas. As a result, we intend to leverage our success in using our centralized process to implement lung cancer screening within a virtually integrated system, expanding our service area to include these eight additional counties supported by two new satelli...

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Need: Evidence-based interventions to effectively decrease preventable disease, disability and death caused by tobacco use are much needed in Tarrant and its surrounding counties. As within the original service area, 15% of age-eligible residents are estimated to be active smokers in the proposed expansion region. The expansion region also maintains higher rates for both lung cancer incidence and mortality, as compared to the state of Texas. As a result, we intend to leverage our success in using our centralized process to implement lung cancer screening within a virtually integrated system, expanding our service area to include these eight additional counties supported by two new satellite screening sites, while continuing to optimize lung cancer screening delivery in the existing 18 county service area. Through this expansion, we will target approximately 85,000 screen-eligible patients, providing opportunities to participate in comprehensive lung cancer screening, serving at least 1,200 patients with nurse-driven clinical navigation, screening and follow-up care, while further supporting these efforts with tobacco cessation education and counseling. Overall Project Strategy: The Lung Cancer Screening and Patient Navigation (E-LSPAN) program will leverage existing framework including community outreach and health promotion, comprehensive lung cancer screening with nurse-driven clinical navigation through follow-up and treatment where appropriate, supported by tobacco cessation education and counseling and education, and centralized reimbursement for local providers. Our evidence-based program will bring lung cancer screening into real-world settings across rural and underserved North Texas, including eight additional counties. Providers identified through targeted community outreach will refer screen-eligible patients to the program once share-decision making has occurred. These patients will then receive lung cancer screening supported by telephone-based navigation, with tobacco cessation education counseling being offered to patients who are active smokers. Linkage to care will be navigated by the program team and delivered by clinical partners within the region. E-LSPAN will provide multilevel support to facilitate completion of the screening episode as defined for lung cancer, up to and including the start of treatment. A patient-centered approach to quality metrics will standardize the evaluation approach, allowing for comparisons between organ sites and identify potential intervention points within the screening process to support optimization of delivery and improve screening process outcomes. Specific Goals: The primary intent of this proposal is to expand our successful comprehensive lung cancer screening program to eight additional counties, while adding two new satellite screening sites, in addition to continuing to serve the original 18 county service area. The specific goals are: 1) optimize the delivery of lung cancer screening services within our virtual integrated system, overlaying a unified framework to our centralized process to identify and address key stress points across the screening continuum using patient-centered quality metrics; and 2) to support lung cancer screening efforts with a reduction in tobacco use among active smokers through evidence-based education and counseling. The project will reach more than 85,000 screen-eligible patients and provide at least 3,410 clinical services to more than 1,215 patients. Services will include 1,215 initial and 1,688 annual LDCT screenings, along with 367 follow-up services for patients with abnormal screening results (57 PET, 280 interval screenings, and 30 biopsies/bronchoscopies). Given approximately half (50.86%) of participants are expected to be active smokers, who will also be engaged in telephone-based tobacco cessation counseling, the program is also expected to provide at least 8,671 navigation/tobacco cessation counseling service encounters. The E-LSPAN program also creates the opportunity to evaluate quality for LDCTs performed both at the satellite sites, as well as UTSW-MCI, and more systematically understand LRAD scoring patterns. These results will then be used to create tailored education and training for providers. Significance and Impact: Building on the success of the original L-SPAN program, the expansion will create the opportunity for even more patients to receive recommended clinical services through the removal of barriers such as cost, access, and challenges of navigating the healthcare system, while adding a primary prevention component of tobacco cessation education and counseling. Leveraging existing infrastructure and the successful county-tailored delivery model will help to ensure prevention services reach those communities disproportionately impacted by cancer, including low-income, minority, uninsured or underinsured patients residing in rural and underserved counties across North Texas.

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