Closing the Gap: A Resident-Led Quality Improvement Project to Improve Colorectal Cancer Screening in Primary Care Community Clinics.

BACKGROUND: Despite the prevalence and mortality associated with colorectal cancer (CRC), 67.4% of US adults aged 50 to 75 years received recommended screening tests in 2016. OBJECTIVE: We created a quality improvement project in resident-run outpatient clinics to increase CRC screening rates to ≥ 50% from 2016 to 2018, with emphasis on vulnerable patient populations. METHODS: We applied a comprehensive, multidisciplinary approach involving internal medicine and family medicine residents and staff from various hospital network departments, selecting 4 clinics to participate whose screening rates were below our network's average of 41%. Our intervention consisted of a needs assessment, resident-led educational sessions for clinicians, staff, and patients, use of fecal immunochemical tests as a first screening option, and application of care gap analysts at each clinic to answer patients' screening questions and to follow up regarding their screening status. RESULTS: We obtained approximately 100 patient surveys from each clinic, a 100% staff completion rate (68 of 68), and a 90% clinician completion rate (85 of 94). Staff and clinician surveys revealed concerns about reducing patient screening fears, inconsistent documentation of screening outcomes, and need for education about CRC prevention, early detection, and screening recommendations. Patient surveys revealed educational deficits and concerns about perceived screening obstacles (eg, transportation and insurance). While CRC screening rates increased across all participating clinics, one clinic experienced an increase from 23% to 48%. CONCLUSIONS: Our multitargeted approach in primary care residency practices yielded increased CRC screening rates in vulnerable patient populations.

Discussion suppers as a means for community engagement.

PURPOSE: This paper describes how Lehigh Valley Hospital and Health Network (LVHHN), a large tertiary care urban hospital, used discussion suppers as a means for community engagement designed to lead to community health improvement. An overview of the implementation of the project is described. PROJECT: In 1996, with an awareness of the need to address population-based health improvement, the Dorothy Rider Pool Health Care Trust and LVHHN undertook a multiyear, multidimensional effort to improve health and quality of life in the Lehigh Valley of Pennsylvania. Data were obtained via a series of community and health assessments. Action-Oriented Community Diagnosis and the Behavioral Risk Factor Surveillance System survey, a national instrument, are 2 assessments discussed. The community was engaged through a series of discussion suppers in which community data were shared in a friendly, interactive fashion. The process included community definition of priorities from the data and the subsequent determination of corresponding actions (programs). CONCLUSIONS: The success of these activities demonstrates the discussion suppers were an effective approach and that data can be shared with rural areas in ways that build partnerships and provide a basis for joint actions. This is increasingly important as communities expect our health care systems to provide care both within the hospital as well as outside its walls.