title: Colorectal cancer screening in primary care: translating research into practice.
abstract: 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.
authors.affiliation: Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. ornstesm@musc.edu
authors.forename: Steven
authors.initials: S
authors.lastname: Ornstein
authors.forename: Lynne S
authors.initials: LS
authors.lastname: Nemeth
authors.forename: Ruth G
authors.initials: RG
authors.lastname: Jenkins
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nietert
mesh_terms: 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
references.citation: NIH Consens State Sci Statements. 2010 Feb 4;27(1):1-31
references.pmid: 20140035
references.citation: Ann Intern Med. 2008 Nov 4;149(9):627-37
references.pmid: 18838716
references.citation: Arch Intern Med. 2009 Feb 23;169(4):364-71
references.pmid: 19237720
references.citation: Contemp Clin Trials. 2009 Mar;30(2):129-32
references.pmid: 18977314
references.citation: Ann Intern Med. 2008 Nov 4;149(9):659-69
references.pmid: 18838717
references.citation: CA Cancer J Clin. 2007 Nov-Dec;57(6):354-66
references.pmid: 17989130
references.citation: Eval Health Prof. 2006 Mar;29(1):65-88
references.pmid: 16510880
references.citation: Implement Sci. 2007 Apr 02;2:11
references.pmid: 17407560
references.citation: Jt Comm J Qual Patient Saf. 2008 Jul;34(7):379-90
references.pmid: 18677869
references.citation: J Gen Intern Med. 2007 Aug;22(8):1195-205
references.pmid: 17534688
references.citation: Ann Intern Med. 2010 May 18;152(10):668-76
references.pmid: 20388703
references.citation: Health Promot Pract. 2011 Mar;12(2):229-34
references.pmid: 19297657
references.citation: J Am Board Fam Med. 2009 Mar-Apr;22(2):141-6
references.pmid: 19264937
references.citation: Stat Med. 2001 Feb 15;20(3):391-9
references.pmid: 11180309
references.citation: Am J Prev Med. 2009 Jul;37(1):8-16
references.pmid: 19442479
references.citation: Am J Epidemiol. 1994 Aug 1;140(3):279-89; discussion 300-1
references.pmid: 8030631