Improving Colorectal Cancer Screening Among the Medically Underserved

An Evidence-Based Practice

Description

This program used a physician-directed intervention to improve rates of recommendation and colorectal cancer screening among medically underserved patients. The pilot study was implemented at a federally qualified health center that serves low-income African-American and Hispanic patients, and was available to patients over age 50 that were not in adherence with screening recommendations. The program used a physician-directed continuous quality improvement strategy to improve colorectal cancer screening rates. The strategy involves four components: 1) manually tracking eligible patients by age and screening status, 2) distributing a physician letter and patient education materials to eligible patients prior to their appointment, 3) informal training with physicians to review health literacy communication principals that help patients understand screening tests, address barriers, and develop a plan of action, and 4) establishing a feedback loop for the clinic to monitor improvement in screening completion and recommendation rates.

Goal / Mission

The goal of this program is to increase provider recommendation and patient compliance with colorectal cancer screening at a federally qualified health center serving low-income patients.

Impact

The intervention appears to be a feasible means to improve colorectal cancer screening rates among patients served by community health centers. However, more attention to patient decision making and education may be needed to further increase screening rates.

Results / Accomplishments

The pilot study was evaluated using a pre- and post-test design, comparing screening and recommendation rates at baseline and 1-year following the intervention (n=154). Screening rates significantly increased from 11.5% at baseline to 27.9% at follow-up (p < 0.001). Physician recommendation increased from 31.6% at baseline to 92.9% at follow-up (p < 0.001). The main reasons for nonadherence included patient readiness (60.7%), competing health problems (11.9%), and fear or anxiety concerning the procedure (8.3%).

The total cost for implementing the intervention was $4,676, and the incremental cost-effectiveness ratio for the intervention was $106 per additional patient screened by colonoscopy.

About this Promising Practice

Organization(s)
Feinberg School of Medicine, Access Community Health Network
Primary Contact
Michael Wolf
750 N Lake Shore Drive, 10th Floor
Chicago, IL 60611
312-503-5592
mswolf@northwestern.edu
http://www.healthliteracy.northwestern.edu/
Topics
Health / Cancer
Health / Prevention & Safety
Organization(s)
Feinberg School of Medicine, Access Community Health Network
Source
Journal of General Internal Medicine
Date of publication
10/22/2007
Date of implementation
2005
Geographic Type
Urban
Location
Chicago, IL
For more details
http://www.pubmedcentral.nih.gov/articlerender.fcg...
Target Audience
Adults, Racial/Ethnic Minorities

Related Promising Practices

  1. Direct Mailing of Fecal Occult Blood Tests to Increase Colorectal Cancer Screening
  2. Colorectal Cancer Screening Intervention for Veterans
  3. Patient and Physician Reminders to Promote Colorectal Cancer Screening
  4. Provider Intervention to Improve Colorectal Cancer Screening
  5. Culturally Tailored Navigator Program for Colorectal Cancer Screening
  6. Increasing Colorectal Screening Among Filipino Americans

More

Related Content for: Improving Colorectal Cancer Screening Among the Medically Underserved

An Evidence-Based Practice meets the following HCI criteria:

  1. The program description includes at a minimum: the sponsoring organization, program goals, program implementation steps, and outcomes that have demonstrated program success in achieving the program goal in one or more localities.
  2. The results from an evaluation of the program include quantitative measures showing improvement in the outcome(s) of interest after the implementation of the program (i.e. increase in smoking cessation, not just the delivery of a smoking cessation program). The outcome measure(s) is/are compared at relevant time periods before and after the intervention or program implementation. Alternatively, the evaluation study compares the outcome(s) between an intervention group and an appropriate control group.
  3. The study is of peer-review quality and presents numbers in a scientific manner; measurements of precision and reliability are included (e.g. confidence intervals, standard errors), results from statistical tests show a significant difference or change in the outcome measure(s), and relevant point estimates and p-values are presented. Note: if the results from an evaluation of a program are presented in a scientific manner and the outcome measure is improved compared to the baseline measurement or the control group but the difference is not statistically significant, the practice is classified as effective and not evidence-based.