title: A Prospective Six Sigma Quality Improvement Trial to Optimize Universal Screening for Genetic Syndrome Among Patients With Young-Onset Colorectal Cancer.
abstract: BACKGROUND
  Improving the quality of health care is a national priority, and providing patient-centered care is one of the 6 key areas for quality improvement. In the setting of patients with young-onset colorectal cancer (CRC), appropriate genetic workup and testing for potential underlying inherited CRC syndromes is fundamental to patient-centered care. Lynch syndrome (LS) is the most common of these inherited syndromes, and current recommendations from the NCCN and other professional societies advocate universal screening for LS among young patients with CRC. However, practical implementation of these guidelines often falls short.
  
  
  METHODS
  We conducted a prospective quality improvement intervention trial to optimize universal screening for LS in young (age <50 years) patients, involving 356 eligible patients during the 12-month preintervention period and 299 patients during the postintervention.
  
  
  RESULTS
  Applying the Six Sigma conceptual framework, we demonstrated a significant increase in use of tumor-based molecular testing and subsequent confirmatory germline mutation testing for LS. This led to identification of more patients to be managed as having LS and of more first- and second-degree relatives to benefit from the testing results.
  
  
  CONCLUSIONS
  This study demonstrated the successful application of a quality improvement conceptual framework for the universal adoption of molecular biomarker testing in patients with cancer, and for improving adherence to NCCN Clinical Practice Guidelines in Oncology for CRC Screening. As molecular and genetic testing is becoming increasingly common, we present a prototype study for improving the adoption of molecular studies and the provision of guideline-based patient-centered care.
authors.affiliation: From the Departments of Surgical Oncology, Gastroenterology and Hepatology, Pathology, Quality Improvement, and Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Sean
authors.initials: S
authors.lastname: Dineen
authors.affiliation: From the Departments of Surgical Oncology, Gastroenterology and Hepatology, Pathology, Quality Improvement, and Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Lynch
authors.affiliation: From the Departments of Surgical Oncology, Gastroenterology and Hepatology, Pathology, Quality Improvement, and Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rodriguez-Bigas
authors.affiliation: From the Departments of Surgical Oncology, Gastroenterology and Hepatology, Pathology, Quality Improvement, and Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bannon
authors.affiliation: From the Departments of Surgical Oncology, Gastroenterology and Hepatology, Pathology, Quality Improvement, and Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Melissa
authors.initials: M
authors.lastname: Taggart
authors.affiliation: From the Departments of Surgical Oncology, Gastroenterology and Hepatology, Pathology, Quality Improvement, and Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Colleen
authors.initials: C
authors.lastname: Reeves
authors.affiliation: From the Departments of Surgical Oncology, Gastroenterology and Hepatology, Pathology, Quality Improvement, and Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Cathy
authors.initials: C
authors.lastname: Modaro
authors.affiliation: From the Departments of Surgical Oncology, Gastroenterology and Hepatology, Pathology, Quality Improvement, and Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: Overman
authors.affiliation: From the Departments of Surgical Oncology, Gastroenterology and Hepatology, Pathology, Quality Improvement, and Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: George J
authors.initials: GJ
authors.lastname: Chang
authors.affiliation: From the Departments of Surgical Oncology, Gastroenterology and Hepatology, Pathology, Quality Improvement, and Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: John M
authors.initials: JM
authors.lastname: Skibber
authors.affiliation: From the Departments of Surgical Oncology, Gastroenterology and Hepatology, Pathology, Quality Improvement, and Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Y Nancy
authors.initials: YN
authors.lastname: You
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D003123:Colorectal Neoplasms, Hereditary Nonpolyposis / Q000175:diagnosis* / Q000235:genetics*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D058996:Quality Improvement; D055815:Young Adult