Back to Basics: Improving Pandemic-Related Colorectal Cancer (CRC) Screening Rates in a Military-Based Primary Care Clinic

From the 2022 HVPA National Conference

Matthew Genelin BA (University of Colorado School of Medicine), Jaime Baker MD, Heather Cassidy MD

Background

Colorectal cancer (CRC) is the third leading cause of cancer death in the United States. Preventative screening is associated with a 65% risk-reduction in CRC-related death. National goals identify 70% as the minimum capture rate of eligible patients for CRC screening. Cancer screening on eligible patients has been significantly impacted during the COVID-19 pandemic, seen as decreased preventative care visits secondary to patient fears over contracting illness and subsequent patient isolation from healthcare. This has created increasing concern of excess CRC-related deaths related to missed or delayed screenings during the pandemic. CRC cancer screening in military healthcare facilities is traditionally better than average, but the strain from COVID-19 is evident. As the pandemic slows and patients return to clinic, this study highlights the increased need to address the care-gap resulting from pandemic-related missed screenings.

Objective

We endeavored to determine the impact of COVID-19 pandemic on CRC screening in our military practice. Following a needs assessment, we employed a quality improvement study which implemented an educational session to staff and a redesigned patient intake form to increase screening rates of eligible patients.

Methods

Between October 2021 and March 2022, randomly selected patients between 50-74 years old without a current cancer diagnosis who visited a military-based internal medicine clinic for annual exam were retrospectively reviewed for CRC screening eligibility and referrals. Following a baseline needs assessment, a 30-minute background education presentation was delivered to clinical staff and providers. Subsequently, a CRC screening box was added to the patient intake forms used for rooming patients. Patient charts were retrospectively reviewed at baseline, 3-months, and 6-months for screening eligibility and referral placement.

Results

Randomly selected patient charts of 60 patients were retrospectively reviewed at all 3 timepoints, totaling 180. At baseline, 3-months, and 6-months, 55%, 53%, and 62% of patients visiting for annual preventative examination were not up-to-date on CRC screening, respectively. At baseline, only 21% of these patients had referrals placed for screening. At 3-months following the delivery of the educational program, 63% of eligible patients had referrals placed. At 6-months, following both the educational program and patient intake form alterations, 78% of eligible patients had referrals placed.

Conclusions

We found our baseline mid-pandemic screening rate of eligible patients to be 21%, well below the national minimum goal of 70%. Following a care-team educational program, screening rates increased significantly to 63%. Basic alterations to an intake form used during rooming of patients and during patient handoff resulted in a further increase of screening rates to 78%. Our investigation results further support current data highlighting the negative effects of COVID-19 on cancer screening. Literature suggests solutions to increasing screening rates should be comprehensive, addressing personal, organizational, and societal barriers to screening. We returned to basic QI techniques of educational intervention and process alteration to allow for improvement. Basic quality ideals of team education and process alterations may help to carry preventative medicine out of the pandemic-related healthcare gap.

Clinical Implications

Simple and basic quality improvement interventions regarding clinical education and process alterations are shown to significantly increase the cancer screening rates of eligible patients in a military-based primary clinic. As screening is shown to increase early detection of disease and reduce mortality, these fundamental interventions have significantly improved patient care and outcomes.

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