ACR Bulletin

Covering topics relevant to the practice of radiology

Improving LCS Adherence

The ACR's new education efforts aim to make a difference for patients when it comes to lung cancer screening.
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By participating, you have access to added benefits including quality measures and educational material to help improve your program's performance.

—Shawn D. Teague, MD, FACR
October 25, 2022

The ACR Lung Cancer Screening Registry (LCSR) helps clinicians monitor and demonstrate the quality of lung cancer screenings (LCS) in their practices through detailed feedback reports that include peer and registry benchmarks. Because screening is performed on an asymptomatic population, there is an added responsibility for the medical community to ensure that risks and benefits are adequately measured and monitored. Contributing data to the LCSR not only helps clinicians improve their own quality of patient care, but also helps improve and refine LCS care for everyone at the national level.

The Bulletin recently spoke with Shawn D. Teague, MD, FACR, lead for the ACR’s LCSR Quality Improvement (QI) Education Subcommittee and associate professor with National Jewish Health/University of Colorado about the LCSR’s new QI initiative to help participating facilities use their LCSR reports to improve patient care. A Plan-Do-Study-Act (PDSA) process was developed that offers step-by-step guidance for conducting a QI initiative focused on three LCSR measures: achieving appropriate radiation dose, increasing adherence to annual screening, and improving smoking cessation rates (the latter two LCSR measures are new).

Why has the ACR been pursuing new LCSR QI opportunities?

Our work emphasizes the QI opportunity of the LCSR. It is important to understand the LCSR is not static — as ideas for new LCSR measures and LCS program performance reports arise, the ACR staff and volunteers continue to expand the registry’s scope and functionality. For example, the PDSA process we are working on includes a new reporting tool that enables you to review your LCSR performance data over a custom time period before and after implementing a QI project for one of the three PDSA-focused measures. By utilizing the reporting tool and the PDSA process, the best potential opportunities to improve performance for LCSR Corporate Accounts can be identified. For example, a corporate account with multiple facilities can identify which facilities may benefit the most from implementing a QI project.

What is the intended impact on patients and benefits for participants?

Improving patient outcomes is the overarching goal of the program with a focus on smoking cessation and identifying lung cancer at the earliest possible stage. In addition, physicians can earn up to 20 CME by completing an LCSR PDSA project, and participation can count as a QI project for your ABR Part IV Maintenance of Certification credit.

How is new data helpful for sites looking to better serve patients through LCSR participation?

We are giving practices the data to help guide their effectiveness. For example, they can find out what percentage of patients are coming back for their annual LCS — and how each site compares
to similar radiology sites around the country. It is a way to discover how well they are performing. We have also created educational resources and suggested tactics to support LCS sites in improving performance on each of the three measures. We have seen participation continue to increase in the LCSR and know people are finding value in it, but we want to continue to develop new value-added features.

Improving patient outcomes is the overarching goal of the program with a focus on smoking cessation and identifying lung cancer at the earliest possible stage.

—Shawn D. Teague, MD, FACR

What is the LCSR QI Education Subcommittee working on around adherence to annual screening?

The adherence to annual screening measure identifies the percentage of patients enrolled in an LCS program who adhere to the recommendation of a yearly routine screening CT. These patients may not have anything concerning detected from prior scan results; however, published research documents the importance of an annual screening for eligible patients to detect lung cancer at an early stage — similar to patients who are recommended to have an annual routine screening mammogram. Prior to this project, the measure and performance data were not available.

What role does CMS play in changes to the LCSR?

CMS no longer requires reporting to the LCSR’s database for reimbursement. However, we believe there is continued added value to participating in the LCSR. By participating, you have access to added benefits including quality measures and educational material to help improve your program’s performance.

What is the value of the PDSA process?

The LCSR’s QI initiatives help facilities collate and review their LCSR data and provide step-by-step guidance for conducting a QI initiative using a PDSA process. The PDSA worksheet is a useful tool for developing a plan, observing and learning from the initial results, and determining what modifications should be made. Modeled after the Institute for Healthcare Improvement’s “Methods
and Tools for Breakthrough Improvement” (the PDSA worksheet used by hundreds of healthcare organizations), the LCSR PDSA worksheet is tailored specifically for the LCSR performance improvement initiative.

What is the future of the LCSR QI initiative’s work?

We are giving participants in the LCSR a new way to review important quality indicators and providing a process to improve performance by giving them custom reporting tools, templates, and how-to educational material to improve quality toward achieving program excellence. To get started, read the Knowledge Base article “LCSR Performance Improvement Overview” in the NRDR Support portal. The radiation dose project is currently available, and the adherence project will be available by the end of the year.

Author Chad E. Hudnall  senior writer, ACR Press