The utility of an evidence-based lecture and clinical prompt as methods to improve quality of care in colorectal cancer screening.
OBJECTIVE
Colorectal cancer screening can decrease both the incidence of and mortality from colorectal cancer. Unfortunately, participation rates remain suboptimal. We assessed whether an evidence-based lecture or a written clinical prompt at the time of a patient visit would independently increase colorectal cancer screening rates in an internal medicine resident clinic.


METHODS
Three-phase prospective cohort trial of 750 patients. The first phase assessed the baseline screening rate. The second phase assessed the screening rate after an evidenced-based lecture. The third phase assessed the screening rate after the addition of written prompts to patient charts. All 50- to 80-year-old patients who met the criteria for colorectal cancer screening were included in the study. The first intervention was a 1-h evidence-based lecture addressing colorectal cancer screening. The second intervention was placing a written prompt on all eligible patients' charts, reminding physicians to assess whether their patient had been screened. Demographic characteristics were assessed for each cohort of 250 patients. The percentage of patients with documented intention to be screened was assessed for each cohort.


RESULTS
The evidence-based lecture did not significantly improve overall attempted screening rates or colon imaging rates relative to baseline. The clinical prompt significantly improved attempts at screening relative to baseline (39.6 to 67.6%) (P<0.0001). Ordering of colon imaging rates also significantly improved after instituting the prompt from 24 to 46% (P<0.0001).


CONCLUSIONS
Clinical prompts are superior to evidence-based lectures for improving physician colorectal cancer screening practices. These prompts are simple low-cost measures that can improve quality of care.
Seres
Kenneth A
KA
Department of Internal Medicine, Section of Digestive Diseases, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA.
Kirkpatrick
Angelia C
AC
Tierney
William M
WM
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003479:Curriculum; D019983:Guideline Adherence; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation; D017010:Reminder Systems