Although screening rates for colorectal cancer have increased in the past decade, rates remain lower than those for mammography and cervical cancer. In fact, there is much room for improvement in colorectal cancer screening in primary care practices, suggests a new study. It found wide variation in how well practices perform evidence-based colorectal cancer screening steps, and suggests several steps that primary care practices can add to raise screening rates.
Clinicians and staff at 15 primary care practices received a written survey asking them about performing four steps associated with screening colonoscopy and seven steps associated with stool blood test screening. From the responses, the researchers were able to calculate the percentage of respondents from each practice who reported that a given step was performed in their practice. Screening colonoscopy steps included ordering and scheduling the procedure, and contacting and rescheduling no-show patients. Similar steps were included for stool blood test screening as well as giving results and sending positive patients for followup colonoscopy.
A total of 205 surveys were received for analysis (72 percent response rate). Wide variation among the 15 practices was discovered when it came to performing individual evidence-based steps. For example, within the stool blood testing category, the second reminder step of contacting nonresponders was only performed by 46 percent of all practices.
Another reminder function, contacting patients with positive stool tests who didn’t appear for followup colonoscopy, had an average performance rate of 62 percent. Rescheduling of no-shows only occurred in 64 percent of practices. Contacting colonoscopy no-shows was performed by 36 percent of practices. Rescheduling colonoscopy no-shows averaged 38 percent.
According to the researchers, adopting health delivery mechanisms, such as patient-centered medical homes, can improve screening rates. Communication and coordination of care between primary care practices and colonoscopy practices can decrease confusion over which steps have been completed. The study was supported in part by AHRQ (Contract No. 290-06-00014).
See "Variation in colorectal cancer screening steps in primary care: Basis for practice improvement," by Mona Sarfaty, M.D., M.P.H., F.A.A.F.P., Ronald E. Myers, Ph.D., Daniel M. Harris, Ph.D., and others in the American Journal of Medical Quality 27(6), pp. 458-466, 2012.