Colorectal cancer screening in primary care: translating research into practice

Med Care. 2010 Oct;48(10):900-6. doi: 10.1097/MLR.0b013e3181ec5591.


Background: Colorectal cancer (CRC) screening is recommended for all adults 50 to 75 years old, yet only slightly more than one-half of eligible people are current with screening. Because CRC screening is usually initiated upon recommendations of primary care physicians, interventions in these settings are needed to improve screening.

Objectives: To assess the impact of a quality improvement intervention combining electronic medical record based audit and feedback, practice site visits for academic detailing and participatory planning, and "best-practice" dissemination on CRC screening in primary care practice.

Research design: Two-year group randomized trial.

Subjects: Physicians, midlevel providers, and clinical staff members in 32 primary care practices in 19 States caring for 68,150 patients 50 years of age or older.

Measures: Proportion of active patients up-to-date (UTD) with CRC screening (colonoscopy within 10 years, sigmoidoscopy within 5 years, or at home fecal occult blood testing within 1 year) and having screening recommended within past year among those not UTD.

Results: Patients 50 to 75 years in intervention practices exhibited significantly greater improvement (from 60.7% to 71.2%) in being UTD with CRC screening than patients in control practices (from 57.7% to 62.8%), the adjusted difference being 4.9% (95% confidence interval, 3.8%-6.1%). Recommendations for screening also increased more in intervention practices with the adjusted difference being 7.9% (95% confidence interval, 6.3%-9.5%). There was wide interpractice variation in CRC screening throughout the intervention.

Conclusions: A multicomponent quality improvement intervention in practices that use electronic medical record can improve CRC screening.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Colonoscopy / statistics & numerical data*
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / epidemiology
  • Colorectal Neoplasms / prevention & control*
  • Confidence Intervals
  • Early Detection of Cancer
  • Female
  • Guideline Adherence
  • Health Plan Implementation
  • Humans
  • Male
  • Mass Screening / organization & administration*
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Odds Ratio
  • Practice Patterns, Physicians' / organization & administration*
  • Primary Health Care / organization & administration*
  • Quality Indicators, Health Care / statistics & numerical data*
  • United States / epidemiology