Improving colorectal cancer screening through Cologuard education: a quality improvement initiative in an urban primary care clinic.

Abstract

Colorectal cancer (CRC) screening is critical for early detection and prevention. A prior analysis at our urban primary care clinic revealed a CRC screening completion rate of 62% in patients who had visited our clinic in the first half of 2023. Identified barriers for lower-than-national-average CRC screening rate included limited awareness and understanding among both providers and patients regarding CRC screening options and processes, particularly Cologuard. To address these gaps effectively, we implemented a series of targeted interventions aimed at increasing Cologuard utilisation. Using an iterative plan-do-study-act model, interventions were implemented from January to September 2024 among average-risk patients aged 45-75 years who presented to primary care visits. Interventions focused on (1) biweekly, small-group provider education sessions with daily reminders, (2) bilingual patient-facing educational materials, posters and instructional videos and (3) electronic medical record portal outreach. The primary outcome was Cologuard completion rate among CRC-screening eligible patients. Process measures were Cologuard order rates and kit return rates, and the secondary outcome was the overall CRC screening completion rates. A total of 2171 CRC-screening eligible patients visited during the intervention period, and a total of 399 Cologuard orders were placed, with 235 completed kits returned. Cologuard completion rates improved from a preintervention median of 7.38%-10.00%. Median order rates rose from 14.59% to 18.71%, and overall CRC screening rates increased from 68.6% to 72.2%. Direct patient messaging had the most immediate impact, with 7.2% responses by recipients, resulting in 16 screenings and a transient peak of 20.71% in monthly Cologuard completion. This project demonstrates that practical, multifaceted, low-cost strategies of provider-focused education and patient-directed digital outreach can significantly improve Cologuard usage, ultimately leading to an increase in CRC screening completion rates. Sustained reinforcement and improvement in kit return will be a key to future improvements.