Improving colon cancer screening rates in primary care: a pilot study emphasising the role of the medical assistant.
BACKGROUND
Colorectal cancer (CRC) is the third-leading cause of cancer death for both men and women in the USA. Despite consensus recommendations for screening, just over half of eligible adults nationally have undergone screening. We therefore implemented a programme to improve the rate of CRC screening.


METHODS
This study was conducted in the Utah Health Research Network and the University of Utah Community Clinics, a 100 000 patient, seven-practice, university-owned system offering primary and secondary care and ancillary services including endoscopy. We focused on patients aged >or=50 who were seen between 1 January 2003 and 31 October 2006, and who were not current for CRC screening at the time of the visit. The study included a three-phase


METHODS
electronic medical record (EMR) reminders, physician and medical assistant (MA) education about CRC screening guidelines, and redesign of patient visit workflow with an expanded role for MAs to review patients' CRC screening status and recommend testing when appropriate. With patient agreement, the MA entered a preliminary order in the EMR, and the physician confirmed or rejected the order. The primary outcome measure was the rate of screening colonoscopy ordered for eligible patients.


RESULTS
The baseline colonoscopy referral rate was 6.0%. Provider education and electronic reminders had minimal immediate impact on screening rates. Addition of the expanded MA role was associated with a sustained increase in colonoscopy referral order rate to 13.4%, a relative improvement of 123%.


CONCLUSIONS
The MA can play a key role in improving CRC screening rates as part of a redesigned system of primary care.
Baker
A N
AN
Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84108, USA. michael.magill@hsc.utah.edu
Parsons
M
M
Donnelly
S M
SM
Johnson
L
L
Day
J
J
Mervis
A
A
James
B
B
Burt
R
R
Magill
M K
MK
D000368:Aged; D002173:Cancer Care Facilities; D002983:Clinical Competence / Q000592:standards; D003110:Colonic Neoplasms / Q000175:diagnosis*; D003113:Colonoscopy / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards*; D010865:Pilot Projects; D017064:Process Assessment, Health Care; D024382:Professional Role; D011785:Quality Assurance, Health Care / Q000379:methods*; D017010:Reminder Systems; D014589:Utah