A Quality Improvement Initiative to Increase Colorectal Cancer (CRC) Screening: Collaboration between a Primary Care Clinic and Research Team

Abstract

Background: Multiple randomized controlled trials have demonstrated that mailed fecal testing programs are effective in increasing colorectal cancer screening participation. However, few healthcare organization in the US have Implemented such programs.

Methods: Stakeholders from one clinic in an integrated healthcare system in Washington State initiated collaboration with researchers with expertise in CRC screening, aiming to increase screening rates at their clinic. Age-eligible individuals who were overdue for CRC screening and had previously completed a fecal test were randomized to receive mailed fecal immunochemical test kits (FIT) at the start of the project (Early) or 6 months later (Late). Outcomes included comparing FIT completion at 6 months by randomization group, and overall CRC screening rates at 12 months. We also assessed implementation facilitators and challenges.

Results: Overall 2,421 FIT tests were mailed at a cost of $10,739. At 6 months, FIT completion was significantly higher among the Early compared to the Late group (62% vs.47%, p <0.001). By 12 months, after both groups had received mailings, 71% in each group had completed a FIT. The clinic's overall CRC screening rate was 75.1% at baseline and 78.0% 12 months later. Key constructs associated with successful program implementation included strong stakeholder involvement, use of evidence-based strategies, simplicity, and low cost. Challenges included lack of a plan for maintaining the program.

Discussion: Collaboration between clinic stakeholders and researchers led to a successful project that rapidly increased CRC screening rates. However, institutional normalization of the program would be required to maintain it.

Figure 1

a: Number of Fecal Immunochemical Tests (FIT) Completed between September 30, 2015 and September 30, 2016 b: Percent of Individuals Completing Fecal Immunochemical Testing in the Early and Late Group between September 30, 2015 and September 30, 2016

Figure 2

Change in Colorectal Cancer Screening rates from September 30, 2015, to September 30, 2016, using HEDIS Specifications* *Denominator includes individuals ages 51–75 with at least two years enrollment, without prior colorectal cancer or colectomy. Numerator includes individuals from the denominator current for colorectal cancer screening defined as a fecal test in the prior year, flexible sigmoidoscopy in the prior 5 years, or a colonoscopy in the prior 10 years.