Closing the Gap: A Resident-Led Quality Improvement Project to Improve Colorectal Cancer Screening in Primary Care Community Clinics

Abstract

Background Despite the prevalence and mortality associated with colorectal cancer (CRC), 67.4% of US adults aged 50 to 75 years received recommended screening tests in 2016. Objective We created a quality improvement project in resident-run outpatient clinics to increase CRC screening rates to ≥ 50% from 2016 to 2018, with emphasis on vulnerable patient populations. Methods We applied a comprehensive, multidisciplinary approach involving internal medicine and family medicine residents and staff from various hospital network departments, selecting 4 clinics to participate whose screening rates were below our network's average of 41%. Our intervention consisted of a needs assessment, resident-led educational sessions for clinicians, staff, and patients, use of fecal immunochemical tests as a first screening option, and application of care gap analysts at each clinic to answer patients' screening questions and to follow up regarding their screening status. Results We obtained approximately 100 patient surveys from each clinic, a 100% staff completion rate (68 of 68), and a 90% clinician completion rate (85 of 94). Staff and clinician surveys revealed concerns about reducing patient screening fears, inconsistent documentation of screening outcomes, and need for education about CRC prevention, early detection, and screening recommendations. Patient surveys revealed educational deficits and concerns about perceived screening obstacles (eg, transportation and insurance). While CRC screening rates increased across all participating clinics, one clinic experienced an increase from 23% to 48%. Conclusions Our multitargeted approach in primary care residency practices yielded increased CRC screening rates in vulnerable patient populations.

Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: A systematic review

“…Studies on ‘patient navigation’ rarely defined this term. Most studies were randomized controlled trials and assessed colorectal cancer screening participation (Appendix ) 15–64 . Participant numbers ranged from 49 49 to 28,929 24,25 .…”

“…Participant numbers ranged from 49 49 to 28,929 24,25 . The most common measure of socioeconomic position was ethnicity/race, 16,17,22,26–28,32,38,40,41,44,47,48,50–52,58,59,62,64 followed by income, 15,20,31,39,48,49,51,52,59,63 and geographic area. 8,18,19,24,25,31,32,45,46,59 Other measures used were health insurance, 15,30,41,48,52,59,64 primary language, 21,29,30,39,40,59,64 language preference, 61 education, 52 health literacy, 15,18,19,26,45,46,50 employment, 49 material deprivation 24,25 or socioeconomic status 32…”

“…The screening methods evaluated were mammography 44–53 and clinical breast examination 47 for breast cancer, cytology 8,54,56–58 and HPV self‐sampling 56,57 for cervical cancer, and fecal occult blood test (FOBT), 15–19,21–26,29,30,32,34–40,42,43 fecal immunochemical test (FIT), 31,41 colonoscopy, 17,20–23,26–32,34–40,42,43 sigmoidoscopy, 21–23,26,29,30,32–37,39,40,43 barium enema 21,29,30,32,34–40 and virtual colonoscopy 32 for colorectal cancer screening. Studies were carried out mainly in the USA, although studies from other geographic areas (Australia, 54 Canada, 58 France, 24,25 UK 56,57 and Zambia 55 ) were also identified.…”

“…Patient navigators were located mainly at a primary care or community level, 8,15–19,21–23,26,27,30–48,50,51,55–58,60,61,63,64 and communicated with participants through phone calls 8,15–25,27–34,36–39,41–48,50–56,58,59,61–64 . In some cases they met in person, 8,18,20,24,25,28,39,42,44–47,49–51,55,58,62 and/or sent lette rs, 22,24,25,50–52,56,61,62 e‐mails 20,23,56,59 or text messages 56,59 .…”

“…Most of them referred the navigators' language, culture or ethnicity (generally because it being the same as that of the study participants), 8,20–22,27,30,39,40,44,47,50–52,58,59,61,63,64 while others indicated their educational level or occupation 8,15,18–20,22,24,25,27,29,30,32,33,37,39,40,43,47,49,57,61,62 . The occupation of the navigators included health educators, 30,47,56,57 nurses, 15,18,19,23,29,30,37,41,42,45 lay persons, 20,27,43,51,62 specialist screening practitioners, 33 community health workers, 30 social workers 24,25 or community leaders 60 . Patient navigators had reached college, 28–30,39,40,61,64 obtained a master's degree 32,53 or bachelor's degree, 22,27,30 or were first year medical students 49 .…”