title: A population management system for improving colorectal cancer screening in a primary care setting.
abstract: BACKGROUND
  Provision of colorectal cancer (CRC) screening in primary care is suboptimal; failure to observe screening guidelines poses unnecessary risks to patients and doctors.
  
  
  OBJECTIVE
  Implement a population management system for CRC screening; evaluate impact on compliance with evidence-based guidelines.
  
  
  METHODS
  
  
  
  METHODS
  A quasi-experimental, prospective quality improvement study design using pre-post-analyses with concurrent controls.
  
  
  METHODS
  Six suites within an academic primary care practice.
  
  
  METHODS
  5320 adults eligible for CRC screening treated by 70 doctors.
  
  
  METHODS
  In three intervention suites, doctors reviewed real-time rosters of patients due for CRC screening and chose practice delegate outreach or default reminder letter. Delegates tracked overdue patients, made outreach calls, facilitated test ordering, obtained records and documented patient deferral, exclusion or decline. In three control suites, doctors followed usual preventive care practices.
  
  
  METHODS
  CRC screening compliance (including documented decline, deferral or exclusion) and CRC screening completion rates over 5 months.
  
  
  RESULTS
  At baseline, there was no significant difference in CRC screening compliance (I: 80.4% and C: 79.6%, P = 0.439) and CRC screening completion rates (I: 78.3% and C: 77.3%, P = 0.398) between intervention and control groups. Post-intervention, compliance rates (I: 88.1% and C: 80.5%, P < 0.01) and completion rates (I: 81.0% and C: 78.1%, P < 0.05) were significantly higher in the intervention group.
  
  
  CONCLUSIONS
  A population management system using closed-loop communication may improve CRC screening compliance and completion rates within academic primary care practices. Team-based care using well-designed IT systems can enable sharing of patient care responsibilities and improve patient outcomes.
authors.affiliation: General Internal Medicine Primary Care, Boston Medical Center, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Wu
authors.affiliation: South Shore Medical Center, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Amara L
authors.initials: AL
authors.lastname: Mulder
authors.affiliation: Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Zai
authors.affiliation: Population Health, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Yuanshan
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Inflexxion, Inc., Boston, MA, USA.
authors.forename: Manuela
authors.initials: M
authors.lastname: Costa
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Lori Wiviott
authors.initials: LW
authors.lastname: Tishler
authors.affiliation: Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Saltzman
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School Center for Primary Care, Boston, MA, USA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Ellner
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Asaf
authors.initials: A
authors.lastname: Bitton
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D011320:Primary Health Care; D011446:Prospective Studies; D058996:Quality Improvement; D017010:Reminder Systems
keywords: care redesign; health information technology; population management; preventive colorectal cancer screening; primary care