Evaluating the impact of electronic reminders for primary care physicians on lung cancer-screening rates

We evaluated the impact of electronic reminders for primary care physicians (PCPs) on lung cancer screening (LCS) rates.

The LCS Health Maintenance Due is an electronic health record-integrated tool that alerts PCPs when patients are due for low-dose computed tomography. Eligible patients were assigned a dynamic screening status on the basis of time since last imaging of the chest. Patients assigned as Not Due, Due Soon, or Due On at rollout were categorized as Baseline Screened, whereas those assigned as Overdue were categorized as Baseline Overdue. We retrospectively evaluated LCS rates at 1 year after rollout and evaluated factors associated with up to date screening status.

Among 8346 eligible patients, 779 (9.3%) were assigned to the Baseline Screened group and 7567 (91%) to the Baseline Overdue group. LCS rates increased from 9.3% at rollout to 16% at 1 year (P < .001). Among patients in the Baseline Screened group, 396 (51%) maintained up to date screening at 1 year, with older age associated with greater odds of remaining up to date (odds ratio [OR], 1.53; P = .003). Among patients in the Baseline Overdue group, 963 (13%) achieved up to date screening at 1 year. Family history of cancer (OR, 2.0; P = .005) was associated with increased odds of screening, whereas greater travel distance (>50 vs <15 miles: OR, 0.38; P < .001), Medicaid/Medi-Cal insurance (OR, 0.58; P < .001), and patients who actively smoke (OR, 0.81; P = .007) were associated with lower odds of becoming up to date.

EHR-integrated electronic reminders for PCPs were associated with significantly increased LCS uptake at 1 year, supporting scalable system-level interventions to improve LCS rates.