A provider intervention to improve colorectal cancer screening in county health centers

Med Care. 2008 Sep;46(9 Suppl 1):S109-16. doi: 10.1097/MLR.0b013e31817d3fcf.


Background: Publicly-funded health centers serve disadvantaged populations who underuse colorectal cancer screening (CRC). Because physicians play a key role in patient adherence to screening, provider interventions within health center practices could improve the delivery/utilization of CRC screening.

Methods: A 2-group study design was used with 4 pairs of health centers randomized to the intervention or control condition. The provider intervention featured academic detailing of the small practice groups, followed by a strategic planning session with the entire health center staff using SWOT analysis. The outcome measure of provider endoscopy referral/fecal occult blood test dispensing and/or completion of CRC screening was determined by medical record audit (n = 2224). The intervention effect was evaluated using generalized estimating equations. Pre-post intervention patient surveys (n = 281) were conducted.

Results: Chart audits of the 1 year period before and after the intervention revealed a 16% increase from baseline in CRC screening referral/dispensing/completion among intervention centers, compared with a 4% increase among controls, odds ratio (OR) = 2.25 (1.67-3.04) P < 0.001. Intervention versus control health center patient self-reports of lack of physician recommendation as a reason for not having CRC screening declined from baseline to follow-up (P = 0.04).

Conclusions: Provider referrals/dispensing/completion of CRC screening within health centers was significantly improved and barriers reduced through a provider intervention combining continuing medical education with a team building strategic planning exercise.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Colonoscopy / statistics & numerical data
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / prevention & control
  • Community Networks / organization & administration*
  • Diagnostic Tests, Routine / statistics & numerical data*
  • Family Practice / statistics & numerical data*
  • Feces / chemistry
  • Female
  • Humans
  • Male
  • Middle Aged
  • Occult Blood
  • Patient Education as Topic
  • Practice Patterns, Physicians' / organization & administration*
  • Program Evaluation
  • Referral and Consultation / statistics & numerical data
  • Rural Health Services / organization & administration*