Improving Colorectal Cancer Screening and Surveillance Compliance with a Multidisciplinary Approach in the Outpatient Setting

Abstract

Introduction: Colorectal cancer (CRC) is a common and preventable malignancy. Studies have shown that removal of premalignant adenomas can prevent cancer and cancer-related deaths. Screening tools have improved the incidence and mortality rates of CRC, along with shifting from late to early stage disease. Therefore, it is important to encourage preventative CRC screening (CRCS) and surveillance by primary care physicians. In this internal medicine outpatient office, compliance rate for CRCS and surveillance was below average at 53% in June 2015. The aim for this project was to develop and implement a tool to improve CRCS and surveillance compliance by 5% within a 12-month time frame among this practice's patients. Methods: We identified barriers to compliance which included lack of health literacy among this patient population, inability to do proper CRCS counseling in a 20-min office visit, and lack of knowledge about fecal immunochemical tests (FIT) as options among medical assistants (MA). We formed a multidisciplinary team of case manager, residents, faculty, and MAs to develop a Plan-Do-Study-Act (PDSA) for performance improvement. We used a quality assessment metrics program called Dashboard to assess compliance. Any patient who was non-compliant in both first and subsequent CRCS were identified. Interventions included educating the MAs on how to use FIT so they are motivated and empowered to provide this to patients, increasing educational information for patients about colonoscopy procedures and offering the option of FIT tests to non-compliant patients, and creating a preventative care form for each visit in order to alert physicians if patients are not up to date on preventative screening. The team met every month to evaluate ongoing progress. Compliance was measured monthly through Dashboard. Results: Since the implementation of the PDSA, compliance for CRCS in the internal medicine outpatient office has continued to improve 1-2% every month. In a 7-month period the compliance rate rose 12% from 53% to 65%. The result of the PDSA accomplished and then surpassed our initial clear aim. Conclusion: The team is continuing to meet on monthly bases to evaluate and modify our metrics to further improve our compliance rate. The implementation of the PDSA with the resulting rapid improvement demonstrates how a multidisciplinary approach for preventative care can improve patients' compliance for CRCS. We hope that this plan can be extrapolated to other gaps in preventative healthcare.Figure 1