From the 2022 HVPA National Conference
Hardik Patel (Doctor of Osteopathic Medicine Cleveland Clinic Foundation), Ian Persits (Doctor of Medicine), Osamah Badwan (Doctor of Medicine), Jacqueline Baikovitz (Doctor of Medicine), Nicole Farha (Doctor of Medicine), Connor Jaggi (Doctor of Medicine), Sarah Khan (Doctor of Medicine), Sara Saliba (Doctor of Medicine), Fadi Toro (Doctor of Medicine), Jessica Donato (Doctor of Medicine)
Background
Colorectal cancer (CRC) is the second leading cause of cancer deaths in the U.S. and yet CDC estimates show that only 68.8% of adults aged 50-75 were up-to-date with CRC screening. Despite the known correlation between early CRC screening and reduction in mortality, screening is vastly underutilized.
Objectives
Our resident-led QI project sought to increase the percentage of patients with up-to-date CRC screening by 25% within six months in the resident primary care panels of nine first-year residents at the Cleveland Clinic.
Methods
The involved resident primary care panels included four different clinic sites at our large academic internal medicine residency program. Data on CRC screening completion was obtained from the Healthy Planet Dashboard in Epic. This dashboard provides a list of eligible individuals (ages 45-75) for a given provider’s primary care panel who were not up-to-date on their CRC screening. Using process mapping and fishbone diagram tools, we determined that the root causes of low rates of CRC screening included the complexity of the colonoscopy scheduling process, limited use of alternatives to colonoscopy, and limited opportunities to promote screening with patients given time restrictions during visits. Based on these drivers, the first intervention focused on identifying patients who had overdue CRC screening and were active on MyChart (MC). A standardized message was sent to these patients emphasizing the importance of CRC screening, Cologuard as an alternative, but still offering the current gold standard (colonoscopy). A second intervention involved telephone outreach to five of the patients from the first cohort who had not completed CRC screening after the first intervention.
Results
The patient panels from eight of the nine residents were included; one clinician’s panel was excluded due to an insufficient number of eligible patients to complete both interventions. At baseline, the key performance indicator (KPI), defined as the number of people with up-to-date CRC screening of those eligible, was 163/325 (50%). Following the first intervention, the percentage of patients with up-to-date CRC screening increased to 55% (180/325) and 58% (188/325) following the second intervention. There was an average 15.35% increase in CRC completion from baseline after both interventions.
Conclusion
Half of the eligible patients in our resident primary care panels failed to remain up-to-date with CRC screening. In order to address the main driving factors within our community, multiple attempts at outreach interventions were attempted with an incremental increase in CRC screening completion. We plan to sustain a third intervention utilizing Colorectal Cancer Awareness month annually as an opportunity to promote screening; this can be done with mass MC messaging with a dot phrase. We believe this work highlights the impact of patient outreach on our local populations through the use of the tools embedded within our Epic system.
Clinical Implications
CRC screening is a priority in primary care but remains a challenging target for improvement. We showed generalizable and practical outreach interventions which have the potential to improve patient outcomes and also provide important opportunities for patient-centered care by including education about acceptable alternatives to colonoscopies.
