Fadi Hawa, MD, Maisoon Torfah, MD, Jaya Gupta, DO, Sanjana Nagra, DO, Afnan Ammar, MD; St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI
Introduction: Colorectal cancer (CRC) is the second leading cause to cancer-related mortality. This has resulted in increased utilization of screening modalities including fecal immunochemical test (FIT), multi-target stool DNA test (MT-sDNA) and colonoscopy. In 2016, 67.2% of the US population who are 50-75 years old were up-to-date on their CRC screening.
Comparatively, CRC screening rates at our academic Internal Medicine resident-based clinic were 42.5%. Therefore, we established a team-based approach to improve the CRC screening program at our community-based clinic. The aim was to achieve a 3% increase in screening rates over the year 2019 which aligns with our organization goal. Methods: Institute of Healthcare model for improvement was used as a framework for this quality improvement project. Initially, a team was assembled, comprised of resident physicians, practice manager (PM) and patient navigators [nurses and medical assistants (MAs)]. Afterwards, a root-cause analysis was performed to identify contributing factors to our low CRC screening rates and explore areas for improvement (Figure 1). Interventions were implemented across three cycles of improvement (Figure 2). This comprised of providing appropriate CRC screening education to the providers and clinic staff. Personal dashboards were then distributed to residents with the list of patients due for screening from their own panel. This was followed by identification of patients due for CRC screening as part of pre-visit planning and during daily inter-professional staff huddles. Furthermore, an educational brochure comparing the different screening modalities was given to eligible patients by MAs prior to seeing the provider. Choice of a screening method was recommended by the provider based on the patient’s CRC risk. Screening tests results were closely tracked and updated by MAs. Patients with incomplete orders after 30 days were followed by a phone call conducted by a resident physician. CRC screening registry was updated on monthly basis by the PM. Results: There was a steady increase in CRC screening rates from a pre-intervention median of 42.5% to 48.5% by the end of December, 2019. Using run chart rules, this change is significant for a positive shift (Figure 3). Discussion: A team-based approach is an effective method to improve CRC screening rates in a resident-based clinic. We anticipate that our intervention will show more measurable outcomes in the future through continuous cycles of improvement.
Figure 1: Root-Cause Analysis for low CRC screening rates. Abbreviations: CRC-Colorectal Cancer, FIT-Fecal Immunochemical Test, MT-sDNA-Multitarget stool DNA, EMRs-Electronic Medical Records
Figure 2: PDSA cycles of improvement. Abbreviations: PDSA- Plan-Do-Study-Act
Figure 2: Run chart graph detailing the exact times for the interventions during the year 2019. A positive Shift can be seen by having six consecutive points above the pre-intervention median. Abbreviations: PDSA- Plan-Do-Study-Act **The red central line reflects the pre-intervention median for the values from June, 2018 to January, 2019.
Disclosures: Fadi Hawa indicated no relevant financial relationships. Maisoon Torfah indicated no relevant financial relationships. Jaya Gupta indicated no relevant financial relationships. Sanjana Nagra indicated no relevant financial relationships. Afnan Ammar indicated no relevant financial relationships.