1. Background Colorectal cancer (CRC) kills an estimated 50,000 Americans annually. 1 The US Preventive Services Task Force (USPSTF) has estimated that attainment of population-level goals for CRC screening could save 18,800 lives annually. 2 Despite widespread availability of these screening techniques, CRC screening remains woefully inadequate with only 52% of Americans screened annually. 3 In the Indian Health System (federal, tribal, and urban Indian health programs) the screening rate for CRC is 29%. 4 Methods Innovations in Planned Care (IPC) Collaborative Indian Health Service (IHS) partnered with the Institute for Healthcare Improvement (IHI). Fourteen pilot Indian Health facilities responded to a request for participation and were enrolled in a Breakthrough Series Collaborative from March 2007 to August 2008. 5 Within each facility, a group of providers and their patients were identified as a clinical “microsystem.” The microsystem teams used rapid cycle improvement methods (plan-do-study-act cycles) as well as process mapping to identify, test and implement a variety of strategies to improve CRC screening. Best practices were communicated to improvement teams in other facilities in the Collaborative to facilitate adoption and replication. Individual microsystem screening rates as well as aggregate collaborative-wide screening rates were tracked using web-based monthly reporting tools (extranet). Results Limitations Conclusions Breakthrough Series Collaborative methods, process mapping and rapid cycle improvement improved CRC screening rates among participating microsystems within Indian Health sites. Further follow-up will be needed to ascertain the durability and spread potential of these improvements. Improved Colorectal Cancer Screening in the Indian Health System Ty Reidhead, MD 1 ; Cindy Hupke, RN, MBA 2 ; Bruce Finke, MD 1 ; Patricia Lundgren, RN, EdD 1 ; Lisa Dolan-Branton, RN 1 ; Lindsay Hunt; Kedar Mate, MD 2 ; Tracy Jacobs, RN 2 ; Nathaniel Cobb, MD, MPH 1 ; Don Goldmann, MD 2 ; Gerald Langley 2 1 Indian Health Service, Rockville, MD, 2 Institute for Healthcare Improvement, Cambridge, MA Results At the outset only 14.3% of microsystems (n =2) had rates of CRC screening above 50%. By August 2008, 42.8% of sites (n=6) had screening rates above 50%. CRC screening rates increased over the 18 month-period from a weighted average of: 32.4% (min 8.5%, max 74.3%) to 57.8% (min 29.7%, max 89.8%) Specific changes that led to these improvements in CRC screening rates: Empanelment of patients Development of care teams Optimization of the roles of and communication among members of the care team Standardization of protocols Testing, referral, and follow-up orders Utilization of the electronic clinical information system for planning, screening reminders, and feedback Identification of opportunities for improvement Partnerships with Community Health Representatives and other non traditional care team members Participating sites self selected to participate and were motivated to improve. There was no control group to compare findings. 1 Ries LA. SEER Cancer Statistics Review, 1975-2005. Bethesda, MD: National Cancer Institute; 2007. 2 USPSTF Screening for Colorectal Cancer Recommendation Statement. 10/08. Also: Maciosek MV, Solberg LI, Coffield AB, Edwards NM, Goodman MJ. Colorectal cancer screening: health impact and cost effectiveness. Am J Prev Med 2006;31:80-9 3 Agency for Healthcare Research and Quality (AHRQ). National Healthcare Quality Report and National Healthcare Disparities Report. 2006 4 Indian Health Service Quality of Care Website: Colorectal Cancer Screening. http://www.ihs.gov/NonMedicalPrograms/quality/index.cfm?module=gpra_cancer3 Accessed 1/14/09 5 The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. (Available on www.IHI.org)