Colorectal Cancer Control Program clinic partners in Maryland, South Carolina, Alabama, and New Hampshire get more of their patients screened for colorectal cancer by reminding their health care providers when their patients are due for screenings.
Two-thirds of the patients at St. Mary’s County Health Department had been screened for colorectal cancer as recommended. Doctors and staff there wanted to raise this number using doctor and patient reminders, and by having case managers follow up with patients.
The health department worked with the MedStar Shah Medical Group’s Medical Arts Clinic to address low screening use in their community. The clinic added provider reminders and improved the care management workflow within its computer system. They set up the computer to run reports so they could see how well new processes were working. The new reminders let staff see if patients with appointments that day had been screened, so they could talk to them and refer them for screening while the patients were in the office. Care managers reviewed the daily report and made sure doctors and patients talked about and scheduled screening tests. The care managers were key to starting the new processes and keeping them going.
The percentage of patients who have been screened went up from 68% in 2017 to 81% in 2018. These practices are now being used throughout the MedStar Shah Medical Group’s health system. Also, the health system is using the new colorectal cancer screening processes to improve their breast and cervical cancer screening processes.
The Sandhills Medical Foundation is a federally qualified health center serving four counties in South Carolina. Two of their clinics, Lugoff and McBee, had low colorectal cancer screening. The Sandhills Medical Foundation did not have a formal process for offering screening to patients.
The Colorectal Cancer Screening Program in South Carolina worked with Lugoff and McBee to let doctors know how well they were doing ordering screenings according to recommendations, including sending them a quarterly report card. The clinics set up provider reminders in their computer system, found a staff member at each clinic to lead the effort, wrote a screening process to be followed, and offered professional education to staff.
As a result, screening increased from 65% in 2015 to 83% in 2018 at Lugoff and from 44% in 2015 to 83% in 2018 at McBee. The Sandhills Medical Foundation was one of only two health centers in South Carolina to achieve the national goal of getting 80% of patients screened for colorectal cancer by 2018.
More than half of patients of federally qualified health centers in seven counties in southern Alabama were not being screened for cancer. They came to the health center for other priority conditions like diabetes or high blood pressure, not cancer screening.
The Alabama Department of Public Health’s Cancer Division worked with the health centers to make changes that they thought could help, including designing a two-sided card with information on breast, cervical, and colorectal cancer screening on one side and colorectal cancer screening on the other side. The receptionist gave these cards to patients to read while they waited to see their doctor and asked them to give the card to the doctor. The cards helped start conversations about cancer screening status and tests. As a result of this reminder card and other changes, within one year, the percentage of age-eligible patients who were screened for colorectal cancer went up from about 9% to 22% across all seven health centers.
Lamprey Health Care, a federally qualified health center in New Hampshire, had low colorectal cancer screening use over the last three years. The New Hampshire Colorectal Cancer Screening Program worked with the health center to raise the percentage of its patients who have been screened as recommended for colorectal cancer. The goal was 52%. Together they reviewed current processes and found ways to improve.
Lamprey Health Care wrote a colorectal cancer screening policy and shared it with all of its clinics. It began using a stool test recommended by the screening program. It named one person at each clinic to make sure the new screening process went smoothly. The health center used the screening program’s patient reminder process document as a guide to help them remind patients when they were due for screening. Lamprey Health Care now calls patients who are overdue for screening and mails them a letter if they can’t reach them by phone.
The changes led to an increase in colorectal cancer screening. Between February and October 2019, Lamprey Health Care raised its screening use from 45.7% to 50%.