Results of a randomized controlled trial to increase colorectal cancer screening in a managed care health plan.
BACKGROUND
Colorectal cancer (CRC) is the third most common cause of cancer deaths; however, rates of regular screening for this cancer are low. A quality improvement (QI) program to increase CRC screening was developed for use in a managed care health plan.


METHODS
Thirty-six provider organizations (POs) contracting with the health plan were recruited for a randomized controlled effectiveness trial testing the QI program. The intervention was delivered over a 2-year period, and its effectiveness was assessed by chart review of a random sample of patients from each PO.


RESULTS
Thirty-two of the 36 POs were evaluable for outcome assessment. During the 2-year intervention period, only 26% of the eligible patients received any CRC screening test. Twenty-nine percent of patients had any CRC screening test within guidelines, with no differences between the intervention or control POs. Significant predictors of having received CRC screening within guidelines were older age (P = 0.0004), receiving care in an integrated medical group (P < 0.0001) and having had a physical examination within the past 2 years (P < 0.0001).


CONCLUSIONS
A facilitated QI intervention program for CRC screening that focused on the PO did not increase rates of CRC screening. Overall CRC screening rates are low and are in need of improvement.
Ganz
Patricia A
PA
Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California 90095-6900, USA. pganz@ucla.edu
Farmer
Melissa M
MM
Belman
Michael J
MJ
Garcia
Christine A
CA
Streja
Leanne
L
Dietrich
Allen J
AJ
Winchell
Charlotte
C
Bastani
Roshan
R
Kahn
Katherine L
KL
D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000592:standards / Q000706:statistics & numerical data*