A provider intervention to improve colorectal cancer screening in county health centers.
BACKGROUND
Publicly-funded health centers serve disadvantaged populations who underuse colorectal cancer screening (CRC). Because physicians play a key role in patient adherence to screening, provider interventions within health center practices could improve the delivery/utilization of CRC screening.


METHODS
A 2-group study design was used with 4 pairs of health centers randomized to the intervention or control condition. The provider intervention featured academic detailing of the small practice groups, followed by a strategic planning session with the entire health center staff using SWOT analysis. The outcome measure of provider endoscopy referral/fecal occult blood test dispensing and/or completion of CRC screening was determined by medical record audit (n = 2224). The intervention effect was evaluated using generalized estimating equations. Pre-post intervention patient surveys (n = 281) were conducted.


RESULTS
Chart audits of the 1 year period before and after the intervention revealed a 16% increase from baseline in CRC screening referral/dispensing/completion among intervention centers, compared with a 4% increase among controls, odds ratio (OR) = 2.25 (1.67-3.04) P < 0.001. Intervention versus control health center patient self-reports of lack of physician recommendation as a reason for not having CRC screening declined from baseline to follow-up (P = 0.04).


CONCLUSIONS
Provider referrals/dispensing/completion of CRC screening within health centers was significantly improved and barriers reduced through a provider intervention combining continuing medical education with a team building strategic planning exercise.
Lane
Dorothy S
DS
Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, New York 11797-8036, USA. dorothy.lane@stonybrook.edu
Messina
Catherine R
CR
Cavanagh
Mary F
MF
Chen
John J
JJ
D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control; D019058:Community Networks / Q000458:organization & administration*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data*; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D015397:Program Evaluation; D012017:Referral and Consultation / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000458:organization & administration*