System-Level Care Improvement Projects in Community Practices and Chronic Pain Management & Cancer Screening

Lung cancer screening (LCS) with low-dose computed tomography is a grade-B USPSTF recommendation and reduces mortality by 20%. Implementation of LCS has never been studied in American Indian and Alaska Native (AI/AN) communities, many of which are at increased risk of lung cancer. For this reason, we initiated the Tribally Engaged Approaches to Lung Screening (TEALS) study in 2019 to co-design and test a tribal community-engaged LCS implementation program. The goals of TEALS are to understand LCS decision-making processes, barriers, and facilitators to guide the implementation of a systematic LCS program within the Choctaw Nation of Oklahoma. TEALS has 4 aims: Aim 1: Identify individual, community, cultural, health system barriers & facilitators that affect LCS implementation in the Choctaw Nation; Aim 2: Use community-engagement processes to co-design a tailored TEALS intervention, which features LCS care coordinators embedded within the CNHSA healthcare delivery system; Aim 3: Measure the impact of the LCS program in a clinical trial, assessing process outcomes at the individual and care delivery system level; Aim 4: Disseminate the LCS program to other health systems. This presentation will describe the TEALS study and its most recent findings and it will also explore successful clinical and care delivery practices that have been able to move the needle on lung cancer screening in a rurally located tribal health community in Oklahoma.