A Provider Intervention to Improve Colorectal Cancer Screening in County Health Centers

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Abstract
Publicly-funded health centers serve disadvantaged populations who underuse colorectal cancer screening (CRC). Because physicians play a key role in patient adherence to screening, provider interventions within health center practices could improve the delivery/utilization of CRC screening. A 2-group study design was used with 4 pairs of health centers randomized to the intervention or control condition. The provider intervention featured academic detailing of the small practice groups, followed by a strategic planning session with the entire health center staff using SWOT analysis. The outcome measure of provider endoscopy referral/fecal occult blood test dispensing and/or completion of CRC screening was determined by medical record audit (n = 2224). The intervention effect was evaluated using generalized estimating equations. Pre-post intervention patient surveys (n = 281) were conducted. Chart audits of the 1 year period before and after the intervention revealed a 16% increase from baseline in CRC screening referral/dispensing/completion among intervention centers, compared with a 4% increase among controls, odds ratio (OR) = 2.25 (1.67-3.04) P < 0.001. Intervention versus control health center patient self-reports of lack of physician recommendation as a reason for not having CRC screening declined from baseline to follow-up (P = 0.04). Provider referrals/dispensing/completion of CRC screening within health centers was significantly improved and barriers reduced through a provider intervention combining continuing medical education with a team building strategic planning exercise.