Population Health Management Approaches to Increase Lung Cancer Screening in Community Health Centers

Lung cancer is the leading cause of cancer-related mortality in the U.S., accounting for approximately 1 in 5 cancer-related deaths. Approximately 80% of lung cancers are attributable to cigarette smoking. Annual Low- Dose Computed Tomography screening for lung cancer (hereafter referred to as Lung Cancer Screening or LCS) is recommended by the U.S. Preventive Services Task Force (USPSTF). Despite evidence of effectiveness and the USPSTF recommendations, implementation of LCS into clinical practice has been exceedingly limited, with only 6.5% of eligible individuals screened in 2020. The long-term goal of this program of research is to increase the reach of LCS at scale among low resource healthcare settings. The proposed project, LungSMART Utah, is a two phase, Sequential Multiple Assignment Randomized Trial (SMART) conducted in Utah Community Health Centers (CHCs). Utah has 14 CHC systems with 50 primary care clinics. Each of the Utah CHCs are Federally Qualified Health Centers, providing comprehensive primary care to >160,000 patients annually. Utah CHC patients are: 50% Latino, 8% Native American, 38% best served in a language other than English, 45% uninsured, and 41% of the clinics are in rural areas (RUCC >4). LungSMART Utah is guided by a comprehensive conceptual framework and is designed to directly address LCS implementation challenges. LungSMART Utah utilizes a Population Health Management (PHM) framework, in which scalable, accessible, and sustainable telehealth interventions are used to engage patients in LCS. Phase 1 of the SMART leverages ubiquitous technologies to enable CHC patients to be assessed for LCS eligibility, engage in Shared Decision Making (SDM) if eligible, and be referred for LCS. Phase 2 of the SMART tests telehealth interventions designed to address logistical barriers and hesitancy around completing LCS among referred patients. LungSMART Utah leverages smartphone/internet technologies when available, and also supports patients whose only telehealth connectivity is a cellphone. A centralized “Hub” enables eligibility assessment, SDM with clinical decision support, screening referral, and screening logistics assistance at scale to help overcome numerous determinants of health that impact low resource settings. All study procedures and interventions will be conducted in English or Spanish based on the patient's preferred language. In sum, LungSMART Utah will be conducted in a real-world context across multiple, independent healthcare delivery systems with limited resources (i.e., CHCs). LungSMART Utah will provide a critical evidence-base for the large-scale implementation of interventions designed to increase LCS at CHCs and other low resource settings nationwide. Project Number: 4UH3CA287109-03 | Fiscal Year: 2026 | NIH Institute/Center: National Cancer Institute (NCI) | Principal Investigator: David Wetter (+2 co-PIs) | Institution: UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH, SALT LAKE CITY, UT | Award Amount: $1,154,997 | Activity Code: UH3 | Study Section: Special Emphasis Panel[ZRG1-HSS-F(90)S] View on NIH RePORTER: https://reporter.nih.gov/project-details/11457456