Award Recipient Highlights

Provider reminders

Reminder cards raise colorectal cancer screening use in Alabama

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. They designed a 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, and asked them to give the card to the doctor. The cards helped start conversations about cancer screening. As a result of this card and other changes, in 1 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.

Clinic quality improvement efforts

Staff focus on increasing colorectal cancer screening at a health center in Chicago

A health center's colorectal cancer screening numbers remained low even though they had tried to improve them in several ways. Part of the problem was lack of time for doctors to educate patients and order stool test kits.

A group of staff members at the health center focused on finding ways to increase colorectal cancer screening. They trained medical assistants on colorectal cancer and how to educate patients. They also sent text messages to patients to remind them to get screened and to return their stool test kits. In addition, they improved provider reports to show the number of patients each provider saw who should have been offered screening, the number of screening orders they placed, and the number of patients who completed screening.

Screening increased from 27% to 49% in 4 years. For Hispanic patients, staff saw an increase in the number of tests ordered (17% to 50%) and returned (3.5% to almost 37%).

Colorectal cancer test choice

Simpler test raises colorectal cancer screening use in Kentucky

Grace Health is a federally qualified health center in the Appalachian region of Kentucky. Many people there have low literacy and a low income. Grace Health used a colorectal cancer screening test kit that required three stool samples, and fewer than 10% of patients completed the test.

The Kentucky Colon Cancer Screening Program worked with Grace Health to find out if more people would complete the screening test if it required only one stool sample instead of three. At one clinic, they gave the simpler one-sample test kits to patients in a stamped return envelope with the estimated return date written on the front. Grace Health also changed the frequency of its provider assessment and feedback reporting from quarterly to monthly.

Nearly two-thirds of patients completed the simpler test kits, and the clinic increased its overall colorectal cancer screening rate from 10% in 2017 to 45% in 2019. Now, all clinics in the Grace Health system use the simpler screening test packaged in a postage-paid return envelope.

Patient navigation

Navigation and other improvements help University of Florida increase colorectal cancer screening

The University of Florida College of Medicine had low colorectal cancer screening use for several reasons. The clinic didn't track screening for the clinic overall or for each doctor. Its doctors offered colonoscopy as the main—and sometimes only—screening test, and patients often had to wait a long time for a colonoscopy appointment. Also, the electronic health record system did not identify patients who needed to be screened.

The university worked with the Florida Department of Health and the American Cancer Society to improve its screening in several ways. The university hired a patient navigator and upgraded the clinic's electronic health record system so it could generate monthly reports on colorectal cancer screening for the clinic and each doctor. The system was also set up to identify patients who were due for screening.

The partners educated clinic staff on colorectal cancer screening recommendations and tests and the clinic began offering stool test kits regularly. They also made colonoscopy appointments available on Saturdays, which reduced screening delays and helped patients who couldn't get screened on weekdays.

The clinic's colorectal cancer screening rate improved from 55% in 2014 to more than 70% by 2019. After seeing success in this first clinic, the university made the same changes in a second clinic, which showed an increase from about 50% to more than 65% from 2018 to mid-2019.

Other highlights

• Iowa Health Center Covers Transportation Costs to Increase Colorectal Cancer Screening: The Eastern Iowa Health Center's patient navigation process, staff teamwork, and free transportation helped patients with low incomes get screened for colorectal cancer.
• West Virginia Clinic Raises Its Colorectal Cancer Screening Rate: Calling patients to remind them about appointments and tests can increase screening. See how West Virginia's program worked with one clinic to increase screening.
• New Strategies Bring Big Rewards in Florida: A St. Petersburg clinic more than doubled its colorectal cancer screening rates by reaching out to patients more directly and helping them overcome barriers to care.