Improving Colorectal Cancer Screening and Follow-up: Results of a Multi-Organization Quality Improvement...

Colorectal cancer (CRC) screening rates in the United States remain below national targets, and follow-up after abnormal stool-based testing is frequently incomplete. This study evaluated changes in CRC screening rates, age-based screening disparities, and 90-day follow-up colonoscopy completion among health care organizations participating in a national quality improvement learning collaborative. Using a mixed-methods, pre-test post-test design, 18 health care organizations serving approximately 3.9 million patients aged 45-75 years reported quarterly aggregate data from the third quarter of 2023 through the first quarter of 2025. Up-to-date (UTD) screening rates and 90-day follow-up colonoscopy completion after abnormal non-colonoscopy results were stratified by age group (45-49, 50-64, and 65-75 years). Group averages and within-organization changes were assessed using chi-square tests and paired t-tests, and qualitative implementation data were analyzed using the Consolidated Framework for Implementation Research. The group average UTD screening rate increased from 61.3% to 66.2%, a 4.9-percentage-point improvement (P < 0.001), corresponding to an estimated 133,538 additional patients screened. Ninety-day follow-up colonoscopy completion increased from 36.2% to 42.9% (P = 0.005). The screening gap between patients aged 45-49 years and those aged 65-75 years narrowed from 35.7 to 26.3 percentage points (P < 0.001). High-impact implementation strategies included readiness assessment, facilitation, data infrastructure development, coalition-building, and performance feedback. Participation in a structured national learning collaborative was associated with meaningful improvements in screening, follow-up, and equity across diverse organizations, supporting collaborative, data-driven approaches to advancing preventive care in population health management. Together, these findings constitute statistically meaningful results across the full screening continuum.