An innovative, multidisciplinary public health model for increasing colorectal cancer screening rates in low income, multicultural patients receiving primary care from a large urban public health department

San Francisco Department of Public Health (SFDPH) provides primary care services for a multicultural, low income, predominantly under/uninsured patient population. Its network of 12 community-based primary care health centers serves 39,000 patients and provides 116,000 medical visits annually.

In 2012, medical assistants, health workers, nurses, and clerical staff from 8 health centers were engaged in an innovative, cost effective multistage model to improve cancer screenings starting with colorectal cancer screening (CRCS). Staff received "just in time" trainings on: using an electronic registry for mail outreach, CRCS guidelines, and using scripts to effectively engage patients in screening. Then, staff immediately practiced the new skills by sending 4800 postcards and conducting same day (as the training) phone outreach with 2400 calls in over 4 languages during a two week period.

An electronic registry was used to identify patients for outreach, match patients with language concordant staff, and track monthly screening rates pre/post intervention. Participant evaluations and video interviews chronicle the experience of the medical assistants and health workers. Pocket tool cards with scripts were also developed.

Four months after the trainings, CRCS rates improved from 43.6% to 50.4% (n=14,000). Staff use the acquired skills and scripts for both proactive outreach and initiating CRCS with patients during clinic visits. This model has been successful in engaging multidisciplinary staff in system-wide, multi-clinic efforts to improve CRCS and can be applied to other preventive and health maintenance screenings. SFDPH plans to apply this model for the second stage on cervical cancer screening in 2013.