Using Quality Improvement and Workflow Analysis to Successfully Implement Evidence-Based Interventions to Increase...

Colorectal cancer (CRC) is the third leading cause of cancer deaths in the United States for men and women combined but is preventable with timely screening. Evidence-based interventions (EBIs) provide promising opportunities to increase screening. There are few descriptive examples of the processes used to assess and implement EBIs to increase CRC screening.

The Colorectal Cancer Prevention Network (CCPN) in South Carolina facilitated an intensive quality improvement technical assistance project aimed to increase CRC screening in 25 primary care clinics. In this paper we provide a detailed description of the process used to implement EBIs, report on the changes in CRC screening rates, and examine the impact of the interventions across clinics with different attributes (such as clinic size and rurality).

We used Chi-square to explore changes in screening rates from baseline to years two and three of clinic implementation. We used Difference-in-Differences analysis to assess changes in screening rates from baseline to third year for clinics with different attributes.

Across all clinics, the CRC screening increased from 45% to 51% (p < 0.05) from baseline to third year of participation. Sixteen of out 25 clinics saw an increase in screening rates for their second year, and 14 out of 25 saw an increase in their third year. Clinics with smaller patient populations, rural clinics, clinics with fewer uninsured patients, and clinics with lower baseline rates saw greater percentage point improvements. Clinics onboarded in the second year saw the lowest gains. We conclude that a structured tailored approach to the selection of EBIs can have positive effects on CRC screening rates, but positive change may vary depending on clinic attributes.