Colorectal cancer screening in primary care: translating research into practice.
BACKGROUND
Colorectal cancer (CRC) screening is recommended for all adults 50 to 75 years old, yet only slightly more than one-half of eligible people are current with screening. Because CRC screening is usually initiated upon recommendations of primary care physicians, interventions in these settings are needed to improve screening.


OBJECTIVE
To assess the impact of a quality improvement intervention combining electronic medical record based audit and feedback, practice site visits for academic detailing and participatory planning, and "best-practice" dissemination on CRC screening in primary care practice.


METHODS
Two-year group randomized trial.


METHODS
Physicians, midlevel providers, and clinical staff members in 32 primary care practices in 19 States caring for 68,150 patients 50 years of age or older.


METHODS
Proportion of active patients up-to-date (UTD) with CRC screening (colonoscopy within 10 years, sigmoidoscopy within 5 years, or at home fecal occult blood testing within 1 year) and having screening recommended within past year among those not UTD.


RESULTS
Patients 50 to 75 years in intervention practices exhibited significantly greater improvement (from 60.7% to 71.2%) in being UTD with CRC screening than patients in control practices (from 57.7% to 62.8%), the adjusted difference being 4.9% (95% confidence interval, 3.8%-6.1%). Recommendations for screening also increased more in intervention practices with the adjusted difference being 7.9% (95% confidence interval, 6.3%-9.5%). There was wide interpractice variation in CRC screening throughout the intervention.


CONCLUSIONS
A multicomponent quality improvement intervention in practices that use electronic medical record can improve CRC screening.
Ornstein
Steven
S
Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. ornstesm@musc.edu
Nemeth
Lynne S
LS
Jenkins
Ruth G
RG
Nietert
Paul J
PJ
D000368:Aged; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D016001:Confidence Intervals; D055088:Early Detection of Cancer; D005260:Female; D019983:Guideline Adherence; D006284:Health Plan Implementation; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
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