225673 From AHRQ ACTION: Colorectal cancer screening steps reported by primary care practices

Sunday, November 7, 2010

Mona Sarfaty, MD MPH , School of Population Health, Thomas Jefferson University, Philadelphia, PA
Randa Sifri, MD , Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
Ronald Myers, PhD , Medical Oncology, Thomas Jefferson University, Philadelphia, PA
Dan Harris, PhD , Health Research and Policy, CNA, Alexandria, VA
Brian Stello, MD , Epicnet Practice Based Research Network, Lehigh Valley Hospital, Lehigh, PA
Amanda E. Borsky , Health Services Research, CNA Corporation, Alexandria, VA
Background. The AHRQ ACTION program seeks to translate research into practice through dissemination and evaluation of evidence-based strategies. In a study intended to improve colorectal cancer (CRC) screening and follow-up in Pennsylvania, primary care practitioners and their office staff were surveyed about whether someone in their practice is responsible for each of the steps required to maximize screening with stool blood testing (SBT) or colonoscopy. The steps included evidence-based approaches such as reminders, tracking for completed tests, and scheduling of needed follow-up.

Methods. Surveys were distributed to 285 practitioners and staff of 15 practices. The survey inquired about 7 steps involved in SBT screening and 4 steps of colonoscopy screening. Options for response were “I do it,” “Another person does it (specify job title),” “No one does it,” and “Don't know.”

Results. Surveys were completed by 205 people (72% response rate). Steps reported were reported as completed (“I do it” or “Another person does it”) by the following percent of respondents: (1) give SBT kit to patients-87%, (2) contact SBT non-adherers-48%, (3) give SBT results to adherers-87%, (4) refer SBT+ patients for follow-up-88%, (5) schedule SBT+ patients for follow-up-75%, (6) contact SBT+ follow-up no-shows-59%, (7) reschedule SBT+ follow-up no-shows-59%. For colonoscopy they were: (1) order colonoscopy-85%, (2) schedule colonoscopy-66%, (3) contact colonoscopy no-shows-32%, (4) reschedule colonoscopy no-shows-31%.

Conclusion. Across all primary care practices, 4 of 5 SBT screening steps were reported as completed by a large majority (>75%). The second step, a reminder function, was completed by less than half of the practices (48%). The first colonoscopy screening step (“orders colonoscopy”) was reported as completed by 75% of respondents; a second step (“schedules colonoscopy”) was identified as completed by only 66%. If screening and follow up rates are to attain a maximal rise, attention should be directed to evidence-based steps that could raise screening rates that are not currently completed in primary care practices.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
List 3 evidence-based steps that lead to higher cancer screening rates in practice.

Keywords: Cancer Prevention, Cancer Screening

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I directed the implementation and data collection for this presentation, and contributed to its development.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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