Improving Compliance of Colorectal Cancer Screening Through Housestaff Education in an Urban Community Hospital: A Quality Improvement Study

Abstract

Introduction: At Brooklyn Hospital Center’s ambulatory Internal Medicine clinic, from 10/1/2016 to 3/31/2017, the rate of colorectal cancer (CRC) screening was reported to be 61%. We believe the low rate of screening is partially due to a knowledge gap regarding appropriate screening guidelines as well as screening alternatives. It is critical for housestaff to understand these guidelines so that we may provide the best and highest quality of care to our patient population. Our hypothesis is that an educational quality improvement intervention will help increase awareness of these guidelines and in turn, indirectly increase the screening rate for CRC. Methods: All Internal Medicine housestaff attending morning conference were included in the study (total of 39). Pre and post-tests were created (Image 1) to examine housestaff knowledge of current guidelines. The pre-test was administered, followed by a brief lecture on current guidelines, after which the post-test was given. The data was collected and analyzed using two-sided tests for significant differences in proportion between the number correct for each question, with a set p-value of < 0.05. Results: The results have been compiled in Table 1 (Image 2). Questions 3, 9, 13 & 15 showed a significant difference in the pre and post-tests. Most housestaff knew that colonoscopy is the preferred prevention test and that FIT is the preferred detection test (as well as FIT being more specific than FOBT). There was a significant increase in their knowledge of the age in which average CRC risk screening should begin. While there was a significant increase in willingness to discuss screening alternatives with patients, overall knowledge of the available alternatives remained low. Conclusion: While this quality improvement study demonstrates significant increase in housestaff knowledge via an educational intervention, there is room for improvement. With the recent introduction of ambulatory FIT, we have a new pathway for alternative screening. Since housestaff did not have a significant increase in knowledge of alternative testing, we theorize that focusing on the newly available FIT as an alternative will increase screening rates. Along with the increased knowledge on average CRC risk screening, this should increase screening via both colonoscopy as well as its alternatives (mainly FIT in our case). Further studies will investigate this, as well as incorporating patient barriers to screening (which are currently being addressed in a pilot study).305_B Figure 2 No Caption available.