Colorectal cancer (CRC) is the third-leading cause of cancer death for both men and women in the USA. Despite consensus recommendations for screening, just over half of eligible adults nationally have undergone screening. We therefore implemented a programme to improve the rate of CRC screening.
This study was conducted in the Utah Health Research Network and the University of Utah Community Clinics, a 100 000 patient, seven-practice, university-owned system offering primary and secondary care and ancillary services including endoscopy. We focused on patients aged >or=50 who were seen between 1 January 2003 and 31 October 2006, and who were not current for CRC screening at the time of the visit. The study included a three-phase
electronic medical record (EMR) reminders, physician and medical assistant (MA) education about CRC screening guidelines, and redesign of patient visit workflow with an expanded role for MAs to review patients' CRC screening status and recommend testing when appropriate. With patient agreement, the MA entered a preliminary order in the EMR, and the physician confirmed or rejected the order. The primary outcome measure was the rate of screening colonoscopy ordered for eligible patients.
The baseline colonoscopy referral rate was 6.0%. Provider education and electronic reminders had minimal immediate impact on screening rates. Addition of the expanded MA role was associated with a sustained increase in colonoscopy referral order rate to 13.4%, a relative improvement of 123%.
The MA can play a key role in improving CRC screening rates as part of a redesigned system of primary care.
"Second, practice processes may affect CRC screening rates. For example, the practices using the EMR required a healthcare team member (usually a nurse) to annually review and document age-appropriate disease prevention in the EMR to keep reminders current at the point of care for each patient . Third, patient characteristics may also be a factor in the screening rates. "
[Show abstract][Hide abstract] ABSTRACT: In the United States, colorectal cancer (CRC) is the third most frequently diagnosed cancer and second leading cause of cancer death. Screening is a primary method to prevent CRC, yet screening remains low in the U.S. and particularly in Appalachian Pennsylvania, a largely rural area with high rates of poverty, limited health care access, and increased CRC incidence and mortality rates. Receiving a physician recommendation for CRC screening is a primary predictor for patient adherence with screening guidelines. One strategy to disseminate practice-oriented interventions is academic detailing (AD), a method that transfers knowledge or methods to physicians, nurses or office staff through the visit(s) of a trained educator. The objective of this study was to determine acceptability and feasibility of AD among primary care practices in rural Appalachian Pennsylvania to increase CRC screening.
A multi-site, practice-based, intervention study with pre- and 6-month post-intervention review of randomly selected medical records, pre- and post-intervention surveys, as well as a post-intervention key informant interview was conducted. The primary outcome was the proportion of patients current with CRC screening recommendations and having received a CRC screening within the past year. Four practices received three separate AD visits to review four different learning modules.
We reviewed 323 records pre-intervention and 301 post-intervention. The prevalence of being current with screening recommendation was 56% in the pre-intervention, and 60% in the post-intervention (p=0.29), while the prevalence of having been screened in the past year increased from 17% to 35% (p<0.001). Colonoscopies were the most frequently performed screening test. Provider knowledge was improved and AD was reported to be an acceptable intervention for CRC performance improvement by the practices.
AD appears to be acceptable and feasible for primary care providers in rural Appalachia. A ceiling effect for CRC screening may have been a factor in no change in overall screening rates. While the study was not designed to test the efficacy of AD on CRC screening rates, our evidence suggests that AD is acceptable and may be efficacious in increasing recent CRC screening rates in Appalachian practices which could be tested through a randomized controlled study.
BMC Health Services Research 05/2011; 11(1):112. DOI:10.1186/1472-6963-11-112 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In surveys, almost 50% of women prefer a female endoscopist (FE) to perform their screening colonoscopies (SCOs).
To assess whether offering women an FE is associated with higher rates of SCOs.
Prospective cohort study.
University of Colorado Hospital primary care clinics.
Women of ages 50 to 69 years eligible for an SCO.
SCO offers through mail and telephone outreach, with and without an explicit FE option.
Outreach intervention differences in SCO completion rates and percentages of women requesting FE.
Of 396 women, 72 (18.2%) underwent SCO without difference by type of invitation. Women who received an FE invitation were more likely to request an FE than patients who received no invitation (44.2% and 4.8%, respectively, P < .001), but women who requested an FE were not more likely to undergo an SCO than those who did not.
SCO was offered through an outreach program rather than through in-clinic referrals. The study used a nonrandomized trial comparison group.
Women offered an FE were not more likely to undergo an SCO than those who were not. This study is unique in describing outcomes associated with actual offers of an FE at the time of scheduling. More direct evidence is needed to support the notion that the absence of FEs is an important barrier to colorectal cancer screening among women.
[Show abstract][Hide abstract] ABSTRACT: Electronic medical records (EMRs) should support clinical decision making to further quality care delivery. This study describes 1 academic medical group's efforts to leverage their EMR's decision-support functionality to improve quality care delivery. A nested, time-series, quasiexperimental design compared 3 different implementation strategies for EMR prompting at 5 primary care clinics in a single academic medical group. The primary outcome was the ordering of all indicated diabetes monitoring tests before the end of the visit. The authors analyzed 16 511 visits performed on 3730 patients. The rate of ordering all indicated tests at the time of the visit increased from 29% with no prompts to 49% (P < .001) with appropriately designed prompts and training support. EMR-generated prompts may be more likely to increase ordering of recommended monitoring tests when clinic workflow, staff training, and medical culture are incorporated into the prompt delivery.
American Journal of Medical Quality 02/2012; 27(5):406-10. DOI:10.1177/1062860611430378 · 1.25 Impact Factor
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