Improving colon cancer screening rates in primary care: A pilot study emphasising the role of the medical assistant

Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84108, USA.
Quality and Safety in Health Care (Impact Factor: 2.16). 10/2009; 18(5):355-9. DOI: 10.1136/qshc.2008.027649
Source: PubMed


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.

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    • "For example, findings from 2 independent studies suggest that frequent screening with HAs may represent an unrealistic workload for practices (Ferket et al., 2010; Mitchell et al., 2008). As with completion of HAs, lessening the burden on staff for follow-up with patients is best accomplished by spreading the effort across the practice team (Baker et al., 2009; Harari et al., 2008; Strecher et al., 2002) and providing adequate training to both staff and providers about how to discuss results with patients (Christianson et al., 2012; Hassan et al., 2009; Miller et al., 2012; Rose et al., 2008). Two studies found that referrals to in-clinic resources were more effective for patients' follow-up on HAs (Cohen et al., 2011; Miller et al., 2012). "
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    • "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 [34]. Third, patient characteristics may also be a factor in the screening rates. "
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