Ivana Deyl, MD, Michael Small, DO, Divya Venkat, MD, Mrudula Gadani, MD; Allegheny Health Network, Pittsburgh, PA
Introduction: While colonoscopy remains the gold standard for colorectal cancer (CRC) screening, in 2016 in the United States only 67.3% of eligible adults were screened for CRC, despite multiple studies showing a 68-88% reduction in CRC mortality in patients receiving CRC screening. With roughly 147,950 new cases expected to be diagnosed in 2020 with a subsequent 53,200 deaths, we created a quality improvement initiative to determine if physician education could have a significant impact on increasing CRC screening adherence in the outpatient setting. Methods: We queried our electronic medical record to harvest the number of patients who qualified for screening colonoscopy, with an average risk for colon cancer (i.e., those without a family history of colorectal neoplasia). From January 2018 through January 2019, a total of 1777 patients over ten residency cohorts at two different locations were found to be eligible CRC screening, we calculated the rate of completed CRC screening amongst these patients. This was calculated as the percentage of patients with either a colonoscopy within the past 10 years, or a flexible sigmoidoscopy over the last 5 years, or a fecal occult blood testing over the last year. Physician education interventions were performed in January 2019. Our educational interventions included an academic day focused on the American College of Gastroenterology (ACG) CRC screening guidelines, the importance of CRC screening, and the percentage of completed CRC screenings per residency cohort over the past year. We then calculated the difference in percentages of completed CRC screenings by each of the ten residency cohorts before and after physician education from January 2019 to June 2019. Results: Our results show that physician education increased the percentage of completed CRC screening in the outpatient resident clinics overall. Individual Cohort data can be seen in Figures 1 and 2. Figures 1 and 2 show the percent change from baseline for each residency outpatient clinic cohort at two resident clinic sites, Clinic #1, and Clinic #2, respectively. Discussion: Our study shows that physician education may have an impact on increasing CRC screening percentages in the outpatient setting, despite patient factors. We recommend physician education on the importance of CRC screening, the ACG guidelines for CRC screening, and the percentages of eligible patients who go unscreened.
Figure 1: Shows the percentage improvement in each of the 5 Clinic #1 cohorts. Cohort E showed the most significant results, improving 13.3%. Cohorts A-D also showed positive results, ranging from 0.4%-3.9%.
Figure 2: Shows the increase in the percentage of CRC screening for each of the 5 Clinic #2 cohorts. Cohorts B-D all showed positive results ranging from 6.4%-9.6%, while Cohorts A and E showed negative results at -6.9% and -1.9%, respectively.
Disclosures: Ivana Deyl indicated no relevant financial relationships. Michael Small indicated no relevant financial relationships. Divya Venkat indicated no relevant financial relationships. Mrudula Gadani indicated no relevant financial relationships.