title: Effects of facilitated team meetings and learning collaboratives on colorectal cancer screening rates in primary care practices: a cluster randomized trial.
abstract: OBJECTIVE
  The purpose of this study was to evaluate a primary care practice-based quality improvement (QI) intervention aimed at improving colorectal cancer screening rates.
  
  
  METHODS
  The Supporting Colorectal Cancer Outcomes through Participatory Enhancements (SCOPE) study was a cluster randomized trial of New Jersey primary care practices. On-site facilitation and learning collaboratives were used to engage multiple stakeholders throughout the change process to identify and implement strategies to enhance colorectal cancer screening. Practices were analyzed using quantitative (medical records, surveys) and qualitative data (observations, interviews, and audio recordings) at baseline and a 12-month follow-up.
  
  
  RESULTS
  Comparing intervention and control arms of the 23 participating practices did not yield statistically significant improvements in patients' colorectal cancer screening rates. Qualitative analyses provide insights into practices' QI implementation, including associations between how well leaders fostered team development and the extent to which team members felt psychologically safe. Successful QI implementation did not always translate into improved screening rates.
  
  
  CONCLUSIONS
  Although single-target, incremental QI interventions can be effective, practice transformation requires enhanced organizational learning and change capacities. The SCOPE model of QI may not be an optimal strategy if short-term guideline concordant numerical gains are the goal. Advancing the knowledge base of QI interventions requires future reports to address how and why QI interventions work rather than simply measuring whether they work.
authors.affiliation: School of Medicine, Department of Community Medicine, Mercer University, Savannah, Georgia 31404, USA. shaw_ek@mercer.edu
authors.forename: Eric K
authors.initials: EK
authors.lastname: Shaw
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Ohman-Strickland
authors.forename: Alicja
authors.initials: A
authors.lastname: Piasecki
authors.forename: Shawna V
authors.initials: SV
authors.lastname: Hudson
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Ferrante
authors.forename: Reuben R
authors.initials: RR
authors.lastname: McDaniel
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nutting
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D015179:Colorectal Neoplasms / Q000517:prevention & control*; D017598:Efficiency, Organizational; D005500:Follow-Up Studies; D006284:Health Plan Implementation / Q000458:organization & administration*; D006801:Humans; D007400:Interprofessional Relations; D007857:Leadership; D008403:Mass Screening / Q000458:organization & administration*; D009515:New Jersey; D009936:Organizational Innovation; D011320:Primary Health Care / Q000458:organization & administration*; D011361:Professional Competence; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care
keywords: cancer screening; facilitation; learning collaboratives; primary health care; quality improvement