Closing the Gap on Colorectal Cancer Screening in a Rural Minnesota Healthcare System: A Quality Improvement Project

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Eitzmann, Megan
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Abstract Purpose Statement: The purpose of this quality improvement (QI) project was to improve provider ordering of colorectal cancer screening among eligible adults in a rural healthcare system in south central Minnesota over a 9-week period using a multifaceted intervention. Background: Colorectal cancer (CRC) is the third most prevalent and second most deadly cancer affecting men and women in the United States. Most CRCs occur sporadically so all adults are at risk for developing the disease. However, rural populations are disproportionately affected by CRC and have higher mortality rates compared to urban populations. These disparities are consistent in rural Minnesota compared to the state average as well. Research indicates that CRC screening reduces mortality. Six CRC screening modalities are equally endorsed by the United States Preventive Services Task Force, but CRC screening remains underutilized. Numerous studies have found that the utilization of multicomponent interventions (2+ interventions) increases CRC screening rates by 6-21.6% compared to no intervention at all. Methods: This QI initiative used a multifaceted approach which included provider and staff education on CRC/screening, distribution of a CRC screening algorithm for clinical decision- making, and implementation of a new rooming process. The rooming process used a paper prompt to indicate the patients’ current CRC screening status. If the patient was past-due on screening, an informational brochure was offered to the patient. The provider referenced the paper prompt to note the patient’s CRC screening status. The provider promoted/educated CRC screening to patients past due and ordered a screening method if the patient was agreeable. Results: CRC screening status was evaluated during 298 clinical encounters, and 138 patients (46%) were noted to be past-due on screening. A total of 77 “past due” patients (60%) were agreeable to receiving a CRC screening order. Patients of all age categories (45-75 years of age) received CRC screening orders, and three different modalities were utilized (colonoscopy, FIT, Cologuard). Conclusion: This QI project suggests that a multifaceted intervention led to an increase in CRC screening orders. The long-term implication of increased ordering is increased CRC screening which will thereby decrease CRC incidence and mortality. Keywords: colorectal cancer, screening, intervention, rural
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