Enhancement of Patient-Centered Lung Cancer Screening: The MyLungHealth Randomized Clinical Trial.

Background

To determine whether a patient-facing, EHR-integrated tool combined with clinician-facing clinical decision support improves the identification of LCS-eligible patients and the ordering of low-dose CT compared with clinician-facing tools alone.

确定患者面向的、集成到电子健康记录中的工具，结合面向临床医生的临床决策支持，是否能改善识别LCS合格患者和订购低剂量CT的情况，与仅使用面向临床医生的工具相比。

DESIGN, SETTING, AND PARTICIPANTS: This pragmatic, unstratified, randomized clinical trial with parallel groups was conducted from March 29, 2024, to March 28, 2025, at primary care clinics at University of Utah Health and New York University Langone Health.

设计、设置和参与者：这是一项实用的、未分层的、平行组的随机临床试验，从2024年3月29日到2025年3月28日在犹他大学健康和纽约大学朗格尼健康中心的初级保健诊所进行。

Adults aged 50 to 79 years with a documented smoking history, an active patient portal account, and a primary care visit in the preceding year were included.

纳入标准：年龄在50至79岁之间，有记录的吸烟史，活跃的患者门户网站账户，并在前一年有过初级保健就诊的成年人。

Study 1 enrolled patients with uncertain LCS eligibility (10 to 19 pack-years, unknown pack-years, or missing quit date); study 2 enrolled patients with documented eligibility (20 or more pack-years and currently smoking or quit smoking within 15 years).

研究1招募了不确定是否符合 LCS 标准的患者（10至19包年，未知包年或缺失戒烟日期）；研究2招募了有明确资格的患者（20或更多包年且目前仍在吸烟或在15年内戒烟）。

Methods

The control included the clinician-facing Decision Precision+ tool (preventive care reminders and a shared decision-making tool).

对照组包括面向临床医生的 Decision Precision+ 工具（预防护理提醒和共享决策工具）。

The intervention included the Decision Precision+ tool as well as the MyLungHealth tool, which collected detailed smoking history (study 1) and delivered personalized education and risk/benefit information (studies 1 and 2) via the patient portal in English and Spanish.

干预措施包括使用决策精准+工具以及我的肺部健康工具，后者通过患者门户网站以英语和西班牙语收集详细的吸烟史（研究1）并提供个性化教育以及风险/益处信息（研究1和2）。

main_outcomes_and_measures

The primary outcomes were the proportion of patients newly identified as eligible for LCS (study 1) and low-dose CT ordering rates (study 2) over 12 months.

主要结果是新识别为肺癌筛查（LCS）合格的患者比例（研究1）以及12个月内低剂量CT扫描的订购率（研究2）。

Analyses used intention-to-treatmixed-effects logistic regression.

分析采用了意向治疗混合效应逻辑回归模型。

Results

There were 31 303 randomized participants, including 26 729 in study 1 (13 144 [49.2%] female; 13 580 [50.8%] male; median [IQR] age, 62 [55-69] years) and 4574 in study 2 (2230 [48.8%] female; 2344 [51.2%] male; median [IQR] age, 63 [56-69] years).

共有31,303名随机参与者，其中研究1有26,729名（女性13,144名[49.2%]；男性13,580名[50.8%]；年龄中位数[四分位数间距]为62[55-69]岁），研究2有4,574名（女性2,230名[48.8%]；男性2,344名[51.2%]；年龄中位数[四分位数间距]为63[56-69]岁）。

In study 1, the MyLungHealth tool increased new LCS eligibility identification (635 of 13 412 [4.7%] vs 308 of 13 317 [2.3%]; adjusted odds ratio, 2.19; 95% CI, 1.99-2.42; P < .001).

在研究1中，MyLungHealth工具提高了新的肺癌筛查（LCS）资格识别率（13412名患者中有635名[4.7%]，与13317名患者中有308名[2.3%]相比；调整后的优势比为2.19；95%置信区间为1.99-2.42；P < .001）。

In study 2, low-dose CT ordering was higher in the intervention arm (474 of 2312 [20.5%] vs 434 of 2262 [19.2%]; adjusted odds ratio, 1.16; 95% CI, 1.04-1.30; P = .008).

在研究2中，低剂量CT的开具在干预组中更高（2312名患者中有474名[20.5%]，与2262名患者中有434名[19.2%]相比；调整后的优势比为1.16；95%置信区间为1.04-1.30；P = .008）。

conclusions_and_relevance

In this randomized clinical trial, integrating a patient-centered tool into primary care EHR workflows increased the identification of patients eligible for LCS and the ordering of low-dose CTs.

在这项随机临床试验中，将以患者为中心的工具整合到初级保健电子健康记录(EHR)工作流程中，增加了识别符合肺癌筛查(LCS)条件的患者数量以及开具低剂量CT检查单的数量。

The relative increases in these primary outcomes were substantial, but absolute increases were more modest.

这些主要结果的相对增加是显著的，但绝对增加则更为温和。

Research on more intensive interventions is warranted to evaluate their ability to further improve LCS screening.

有必要进行更密集干预措施的研究，以评估它们进一步提高肺癌筛查（LCS）的能力。

trial_registration

ClinicalTrials.gov Identifier: NCT06338592.

ClinicalTrials.gov 注册号：NCT06338592。