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. 2022 Nov 1;5(11):e2242354.
doi: 10.1001/jamanetworkopen.2022.42354.

Evaluation of a National Quality Improvement Collaborative for Improving Cancer Screening

Rachel Hae-Soo Joung  1 , Timothy W Mullett  2   3 , Scott H Kurtzman  4   5 , Sarah Shafir  6 , James B Harris  2   7 , Katharine A Yao  4   8 , Karl Y Bilimoria  1 , William G Cance  6   9 , Heidi Nelson  2 ; Return-to-Screening Quality Improvement Collaborative
Collaborators, Affiliations

Evaluation of a National Quality Improvement Collaborative for Improving Cancer Screening

Rachel Hae-Soo Joung et al. JAMA Netw Open. .

Abstract

Importance: Cancer screening deficits during the first year of the COVID-19 pandemic were found to persist into 2021. Cancer-related deaths over the next decade are projected to increase if these deficits are not addressed.

Objective: To assess whether participation in a nationwide quality improvement (QI) collaborative, Return-to-Screening, was associated with restoration of cancer screening.

Design, setting, and participants: Accredited cancer programs electively enrolled in this QI study. Project-specific targets were established on the basis of differences in mean monthly screening test volumes (MTVs) between representative prepandemic (September 2019 and January 2020) and pandemic (September 2020 and January 2021) periods to restore prepandemic volumes and achieve a minimum of 10% increase in MTV. Local QI teams implemented evidence-based screening interventions from June to November 2021 (intervention period), iteratively adjusting interventions according to their MTVs and target. Interrupted time series analyses was used to identify the intervention effect. Data analysis was performed from January to April 2022.

Exposures: Collaborative QI support included provision of a Return-to-Screening plan-do-study-act protocol, evidence-based screening interventions, QI education, programmatic coordination, and calculation of screening deficits and targets.

Main outcomes and measures: The primary outcome was the proportion of QI projects reaching target MTV and counterfactual differences in the aggregate number of screening tests across time periods.

Results: Of 859 cancer screening QI projects (452 for breast cancer, 134 for colorectal cancer, 244 for lung cancer, and 29 for cervical cancer) conducted by 786 accredited cancer programs, 676 projects (79%) reached their target MTV. There were no hospital characteristics associated with increased likelihood of reaching target MTV except for disease site (lung vs breast, odds ratio, 2.8; 95% CI, 1.7 to 4.7). During the preintervention period (April to May 2021), there was a decrease in the mean MTV (slope, -13.1 tests per month; 95% CI, -23.1 to -3.2 tests per month). Interventions were associated with a significant immediate (slope, 101.0 tests per month; 95% CI, 49.1 to 153.0 tests per month) and sustained (slope, 36.3 tests per month; 95% CI, 5.3 to 67.3 tests per month) increase in MTVs relative to the preintervention trends. Additional screening tests were performed during the intervention period compared with the prepandemic period (170 748 tests), the pandemic period (210 450 tests), and the preintervention period (722 427 tests).

Conclusions and relevance: In this QI study, participation in a national Return-to-Screening collaborative with a multifaceted QI intervention was associated with improvements in cancer screening. Future collaborative QI endeavors leveraging accreditation infrastructure may help address other gaps in cancer care.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kurtzman reported being the chair of the National Accreditation Program for Breast Centers, a volunteer position. Ms Shafir reported serving as the principal investigator for 2 cooperative agreements between the American Cancer Society and the Centers for Disease Control and Prevention—the Comprehensive Cancer Control Technical Assistance and Training Cooperative Agreement and the Strengthening Hospital Systems Capacity Building for Cancer Prevention and Screening Cooperative Agreement. Dr Cance reported having an advisory role at and his spouse having an equity interest in FAKnostics, LLC, outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Mean Monthly Screening Test Volumes in April Through November 2021
April and May 2021 is the preintervention period. Vertical dotted line indicates the start of the intervention period (June 2021).
Figure 2.
Figure 2.. Total Number of Monthly Screening Tests in Breast, Colorectal, Lung, and Cervical Cancers Across Time
aThe prepandemic period data are shown as monthly mean volumes from September 2019 and January 2020. bThe early pandemic period data are shown as monthly mean volumes for September 2020 and January 2021.
See this image and copyright information in PMC

References

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