Improving Lung Cancer Screening Rates in a Resident-Run Federally Qualified Health Center (FQHC) Through Targeted Patient Outreach and Electronic Health Record (EHR) Care Gap Optimization.

Background and objective Lung cancer continues to be the most common cause of cancer-related death in the United States. While low-dose CT (LDCT) screening has been shown to reduce mortality among high-risk individuals, screening uptake at the national level remains low. Resident-run clinics, particularly those serving as Federally Qualified Health Centers (FQHCs), face unique barriers to implementation, including clinical time constraints and fragmented identification of eligible patients. The objective of the study is to improve lung cancer screening (LCS) rates in high-risk patients in an outpatient resident-run FQHC-Look-Alike through a sequential implementation of targeted patient outreach and electronic health record (EHR) care gap optimization as a quality improvement project. Methods This quality improvement project was conducted at an urban residency clinic. A department-built EHR report identified patients aged 50-77 years with a ≥20 pack-year smoking history. Two interventions were implemented: Phase I: secure EHR messaging to eligible patients, encouraging screening discussions; and Phase II: manual entry of LCS health maintenance modifiers ("care gaps") to trigger point-of-care reminders during active encounters. Data were analyzed using a segmented regression model to assess level and trend changes in monthly screening completion. Results Of the 310 patients identified by the EHR report, 158 (51%) met clinical inclusion criteria and successfully completed LDCT screening during the study period. Following the initiation of interventions, the mean monthly screening completion rate increased from 1.2 to 12.3 scans per month. Segmented regression analysis confirmed a statistically significant level change (coefficient: 11.2; p < 0.001) following the optimization of EHR care gaps, reflecting a sustained improvement in preventive care delivery. Conclusions A dual-modality intervention combining direct patient outreach with provider-facing EHR prompts significantly improves LCS rates in a resident-led safety-net setting. By standardizing the identification of high-risk cohorts and utilizing existing EHR infrastructure for point-of-care alerts, outpatient practices can overcome common implementation barriers. This low-resource, pragmatic approach provides a scalable blueprint for other graduate medical education programs to optimize preventive oncology outcomes.