Developing an Effective Ambulatory Care Process to Improve Rates of Colorectal Cancer Screening Shabana Farooq MD,FAAFP April 27, 2015

Disclosures No disclosures to report

Learning Objectives Evaluate rates of colon cancer screening in own settings Utilize a QI process and effective data tracking to improve screening rates Discuss effectiveness of system-focused educational interventions to improve screen rates

Problem Overview Colon cancer is 2 nd leading cause of cancer related deaths in the United States Colon cancer screening is underutilized Colonoscopy has been preferred screening modality with fecal occult blood testing and flexible sigmoidoscopy as alternatives

Why a QI Project? Targeted institutional rate for colorectal cancer screening was 63% in 2013 –Adults age years who had appropriate screening as documented in electronic record Residency clinical practice offices were 25.5% (A) and 27% (B) in 2013 Did not know what factors or barriers were impacting screening rates

Plan – Do – Study - Act Random chart audit by residents who reviewed 50 electronic health records (25 each office) from 2013 to identify common barriers Inconsistent documentation and communication deficiencies addressed at didactics and preceptor counseling during office hours –Health maintenance update –Problem list update for colon cancer history –Documentation related to screening discussion –Consistency and follow-up screening actually done –Documentation of screening results

The Best Screening Test is the One That Gets It Done Well Fecal occult blood testing – cheap, noninvasive, but many false-positives –Invested in expensive High Sensa FOBT kits –Conducted simulation training in use of kits using anatomical model for rectal & prostate examination –Conducted motivational training for residents to encourage pt. screening by any method

Colonoscopy Barriers Institution currently unable to meet need – not enough practitioners, procedure rooms, support staff or equipment Exploring options for physician recruitment, group visits for pre-procedure education, development of audiovisual resources, pre-packaged bowel prep kits at pharmacy etc.

Did Initiatives Make a Difference? August 2014 – December 2014 Office Monitoring –Discovered 2 residency offices differed in tracking and screening practices –Inconsistent, accuracy questionable System wide Monitoring –Anodyne & Explorys software allow for most accurate tracking electronically – Practice managers now tracking statistics

st Quarter Results 2013 Office A = 25.5% Office B = 27%

Screening Documentation By Type st QuarterColonoscopyFecal Occult BloodFlex Sigmoidoscopy Office A Office B Totals

Remaining Challenges Constant need to reinforce use of routine screening & documentation in office Institution still lacks resources for large scale colonoscopy screening Nursing staff and offices in flux, need champion and well-established written plan for consistency in clinical practice

Questions? Shabana Farooq MD, FAAFP Program Director Mercy Family Medicine 2200 Jefferson Avenue, Toledo OH

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