Improving Colorectal Screening Compliance Through Targeted Quality Improvement Interventions in Primary Care

Colorectal cancer (CRC) is the third most common cancer in the United States, and yet it is one of the most preventable cancers. Despite multiple available screening options, national CRC screening rates remain suboptimal. There is an observed lower participation among middle-aged adults compared with those 65 years and older. Therefore, targeted interventions to improve CRC screening in those younger than 65 years old are needed.

Increase CRC screening rates by 10% among patients aged 45-64 years old in a primary care clinic between July 2023 and May 2024.

A multimodal intervention approach that utilized (1) educational presentations for faculty and nursing staff on processes, indications, risks, and benefits of both invasive and non-invasive CRC screening methods; (2) development and dissemination of educational patient brochures for patients in the clinic; and (3) delivery of electronic patient portal messages containing education on risks of colon cancer and screening modalities to all 2,020 patients who were overdue for CRC screening or had never completed screening. Subsequent automated reminders were also sent on days 15, 30, and 45. The main measure was the monthly CRC screening rate among patients aged 45-64 years old.

CRC screening rates increased from 65.5 to 74.3% over a 12-month period. A more consistent upward trend was seen after Plan-Do-Study-Act (PDSA) cycle 3, which incorporated patient portal messaging and automated reminders.

Implementation of multimodal interventions that include clinician training, patient education, and targeted patient outreach can bring about a positive impact on CRC screening rates. While temporal association suggests these interventions may have contributed to improvements, more rigorous study designs are needed to establish causation.