IMPROVING COLORECTAL CANCER SCREENING IN PRIMARY CARE

Early detection of colorectal cancer (CRC) can be done efficiently by providing a referral for a colonoscopy, fecal immunochemical, or guaiac fecal occult blood kits. In the United States, the National Colorectal Cancer Roundtable (NCCRT) estimated that if providers achieved CRC screening of 80% of the target population by 2018, over 200,000 lives would be saved. Previously, providers only screened about one-third of the targeted patients on average. This was the impetus for the development of a quality improvement (QI) program by the Center of Medicare and Medicaid Services (CMS). As a result, the CMS provides “bonus” reimbursements to clinics meeting the 80% criteria. Starting in 2008, the Medicare Star-Rating Program (MSRP) began tracking primary care clinics’ screening performance according to payors. While demonstrating some success, there were minimal data to explain why other clinics do not achieve recommended scores with their CRC screening. This Doctor of Nursing Practice (DNP) project was designed to increase CRC screening performance levels in a busy Los Angeles primary care practice clinic that has never made baseline scores. The Teamlet Training Pathway (TTP) was used to implement the process with the staff, providers, and patients. Improving provider, staff, and patient education increased the clinic’s CRC screening by more than 10%. The Health Belief Model (HBM) was used to inform whether the interventions changed the clinic staff and providers’ behaviors. The results of this project indicate that the HBM iv and TTP could be effective methods to improve CRC screening in certain outpatient clinics.