Development and impact of a quality improvement intervention to increase lung cancer screening in rural Appalachia
Year: 2026
Type: article
Abstract: Background: Lung cancer remains the leading cause of cancer death in the United States, with rural Appalachian communities experiencing disproportionately high incidence and mortality rates. Limited access to low-dose computed tomography (LDCT) screening, socioeconomic barriers, and cultural factors contribute to delayed diagnoses and poor survival outcomes. The Association of Cancer Care Centers (ACCC)'s Rural Appalachian Lung Cancer Screening Initiative (RALCSI) aimed to reduce these disparities by strengthening the implementation of guideline-concordant lung cancer screening programs through workflow redesign, provider and patient education, and community engagement. The aim of this study was to describe the development and early impact of the RALCSI quality improvement intervention on lung cancer screening in rural Appalachia. Methods: From October 2023 through June 2025, a 10-county focus area in rural Appalachia was selected using epidemiologic data and Rural-Urban Commuting Area (RUCA) classification. A multiple-methods quality improvement (QI) approach was used. Baseline data were collected on site characteristics, screening volumes, and diagnostic yield. Interventions included provider training guided by task force members' expertise and ACCC's Lung Cancer Screening Implementation Change Package, targeted patient outreach adapted for the rural Appalachian context, and process improvements such as electronic health record (EHR) prompts and centralized scheduling. Quantitative metrics (first-time scans, repeat scans, interval scans, and lung cancer diagnoses) were tracked, while qualitative data from provider and patient feedback were analyzed to identify barriers and facilitators. Results: Two participating sites, Pikeville Medical Center (PMC) and Buchanan General Hospital in partnership with the University of Virginia (BGH/UVA), implemented new workflows and education programs to strengthen lung cancer screening. Screening volumes increased over the intervention period, with PMC performing 458 first-time scans and 543 repeat scans-an increase of 83% and 72%, respectively, compared to the 2023 baseline of 250 first-time and 315 repeat scans. PMC diagnosed 10 lung cancers through screening during this period. BGH/UVA conducted 75 first-time scans and 57 repeat scans, representing increases of 108% and 104% compared to the 2023 baseline of 36 first-time and 28 repeat scans, although no lung cancers were diagnosed during the study period. Providers demonstrated increased confidence in applying screening guidelines and engaging patients in shared decision-making, while patient outreach through trusted community channels improved participation. Persistent barriers included transportation challenges, follow-up adherence, accurate identification of eligible individuals for screening, and appropriate coding and billing of lung cancer screening services. Conclusions: Community-informed, systems-based interventions can significantly improve lung cancer screening in rural regions. The ACCC RALCSI model demonstrates the value of combining provider education, culturally sensitive outreach, and workflow redesign to increase early detection and reduce disparities. Future efforts should focus on sustainability, policy-level interventions, and evaluation of long-term outcomes to support equitable access to screening nationwide.
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223917097