title: Improving colorectal cancer screening by targeting office systems in primary care practices: disseminating research results into clinical practice.
abstract: BACKGROUND
  Randomized trials have shown the efficacy of an office systems approach in improving colorectal cancer (CRC) screening behaviors; its feasibility in real-world primary care practices has not been well studied.
  
  
  METHODS
  Between August 1, 2000, and December 1, 2001, we enrolled 185 primary care clinicians identified through purchased database lists. At the end of follow-up (December 31, 2002), 127 clinicians had completed preintervention and postintervention questionnaires. Trained staff from the American Cancer Society visited practices and identified areas for improvement in CRC screening. They provided clinicians with resources, tools, and support to facilitate positive change. We defined 5 clinician behavior areas related to successful CRC screening, including educating patients, identifying patients due for screening, enabling patient compliance, monitoring patient compliance, and notifying patients of their test results. We measured these areas before and after the intervention using questionnaires and data extracted from medical records.
  
  
  RESULTS
  We demonstrated improvements in the passive use of posters and brochures about CRC screening (baseline, 20.5% and follow-up, 69.3%; P<.001) and in the monitoring of fecal occult blood tests using manual tracking systems (baseline, 20.6% and follow-up, 37.3%; P<.05). Based on medical records data among 551 patients, we found a statistically significant increase in the number of patients who became up-to-date with CRC screening recommendations and tests (P< .001 for both).
  
  
  CONCLUSIONS
  Methods shown to improve CRC screening processes in protocol-driven randomized trials may be effective in community practice, and wider dissemination of these strategies shows promise to increase CRC screening.
authors.affiliation: Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA 02115, USA. esther.wei@channing.harvard.edu
authors.forename: Esther K
authors.initials: EK
authors.lastname: Wei
authors.forename: Catherine T
authors.initials: CT
authors.lastname: Ryan
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Dietrich
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005240:Feasibility Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D009780:Occult Blood; D010353:Patient Education as Topic / Q000592:standards; D010824:Physicians' Offices; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013664:Teaching Materials