Patient-centred approach to improve colorectal cancer screening (CRC) in resource-limited communities.

Abstract

The aim of this quality improvement initiative was to increase colorectal cancer (CRC) screening rates from 17.75% and 28.45% to 40% in patients aged 45-49 years and 50-75 years, respectively, at a resource-limited primary care clinic within 1 year. We identified a major gap in CRC screening in both age groups (45-49 and 50-75 years). We implemented multifaceted, patient-centred interventions in a community clinic serving a diverse population. The intervention incorporated the use of stool-based testing (faecal immunochemical test and multi-targeted stool DNA test), colonoscopy referrals, patient navigation, multilingual education, electronic health record alerts and a real-time tracking dashboard. The primary outcome measure was CRC screening completion rates. Colonoscopy and stool test completion rates were the process measures. In 45-49 years, we observed a sustainable, steady increase in CRC screening rates from 17.75% (n=400) to 41.25% during the study period and 59.50% 6 months poststudy, with a median rate of 52.38% in a run chart and a mean of 37.00% in the statistical process control (SPC) chart. In 50-75 years, we observed a sustainable increase in CRC screening rate from 28.45% (n=2879) to 46.16% during the study period and to 61.06% 6 months poststudy, with a median rate of 55.47% in a run chart and mean of 43.00% in a SPC chart. In 45-49 years, colonoscopy completion rates increased from the baseline rate of 25.93% (n=108) to 37.04% during the study period and to 43.52% 6 months poststudy. In 50-75 years, colonoscopy completion rates increased from the baseline rate of 74.01% (n=654) to 92.05% during the study period and to 97.55% 6 months poststudy. We exceeded our goals to increase CRC screening in both age groups. Patient-centred care and system-integrated interventions may substantially increase CRC screening among underserved individuals.