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E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
A population management system for improving colorectal cancer screening in a primary care setting
Charlotte A Wu1, Amara L Mulder2, Adrian H Zai3
1General Internal Medicine Primary Care, Boston Medical Center, Brigham and Women's Hospital, Boston, MA, USA.
Rationale:
Provision of colorectal cancer (CRC) screening in primary care is suboptimal; failure to observe screening guidelines poses unnecessary risks to patients and doctors.
Aims And Objectives:
Implement a population management system for CRC screening; evaluate impact on compliance with evidence-based guidelines.
Design:
A quasi-experimental, prospective quality improvement study design using pre-post-analyses with concurrent controls.
Setting:
Six suites within an academic primary care practice.
Participants:
5320 adults eligible for CRC screening treated by 70 doctors.
Intervention:
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.
Main Outcome Measures:
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.
