Quality Implementation of Lung Cancer Screening System: A System to Support High-Quality Delivery of Lung Cancer Screening in Diverse Settings

The historic National Lung Screening Trial (NLST) reported lung cancer-specific and all-cause mortality reductions associated with low-dose CT (LDCT) imaging, and nearly all relevant authoritative organizations established guidelines and policies supporting implementation and insurance coverage for individuals who meet eligibility criteria. The immediate challenge became translating results into community settings. Early translation showed substantial challenges to delivery of quality lung cancer screening (LCS). The Kentucky Lung Cancer Education Awareness Detection Survivorship (LEADS) Collaborative developed a comprehensive system to evaluate and support LCS delivery in community contexts with an emphasis on supporting rural and low-resource settings. The Quality Implementation of Lung Cancer Screening (QUILS) System 1.0 featured 4 key components: (1) the QUILS Index 1.0, a quantitatively driven evaluation system assessing quality across 6 essential LCS implementation domains; (2) the QUILS Audit and Feedback Process 1.0, a strategy for providing feedback and guidance to bridge the QUILS Index and the QUILS Resource Portal; (3) the QUILS Resource Portal 1.0, online tools and trainings that are directly tied to components within the QUILS Index 1.0; and (4) the QUILS Coaching and Technical Assistance 1.0, providing additional problem-solving and support upon request. The 6 essential domains included: (1) Screening Eligibility; (2) Radiology Operations; (3) Team Operations; (4) Prevention Efforts; (5) Patient Education; and (6) Community Outreach. To collect initial feedback and evaluate the QUILS System 1.0, the investigative team planned and conducted a rigorous evaluation of this initial framework across 10 sites in Kentucky over an 18-month period.