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Aaron Yamasaki, Agnes Catherine Santiano, Marguerite Cazin, Natalie Kamada, Tyler Liu, Jimmy Chen, MD

John A. Burns School of Medicine at the University of Hawaiʻi at Mānoa

Improving Colorectal Cancer Screening Rates in a

West Oʻahu Primary Care Practice

Colorectal cancer (CRC) is the third most common cause of cancer-related mortality in Hawaiʻi¹.

The American Cancer Society National Colorectal Cancer Roundtable has a CRC screening goal of 80%³.

Only 65% of Hawaiʻi’s population between ages 45 and 75 have been screened for CRC².

Low CRC screening rates lead to increased rates of cancer and costs for both patients and health systems.

The baseline screening rate of a population of Hawaiʻi Medical Service Association (HMSA)-insured patients at a large primary care practice in West Oʻahu was low at 45%.

BACKGROUND

GENERAL MISSION & AIM STATEMENT

RESULTS

DISCUSSION

Correcting discrepancies between insurance claims data and EHR data regarding CRC screening status increased the screening rate by 12%.

For the remaining unscreened patients, the most common reason for care gaps was a lack of standardized workflows for addressing CRC screening during in-office visits.

After three PDSA cycles, 44 patients completed FIT screening. One patient had a positive FIT test and was referred to a gastroenterologist.

During patient outreach, some patients described transportation and financial issues as barriers to screening.

REFERENCES

University of Hawaiʻi Cancer Center. Cancer at a Glance 2014-2018, Hawaiʻi Tumor Registry. 2022. Accessed August 12, 2024. https://publications.uhcancercenter.org/r4Yd/p34/p34
American Cancer Society. Colorectal Cancer Facts & Figures 2023-2025. 2023. Accessed August 12, 2024. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/colorectal-cancer-facts-and-figures/colorectal-cancer-facts-and-figures-2023.pdf
American Cancer Society National Colorectal Cancer Roundtable. 80% in Every Community. Accessed August 12, 2024. https://nccrt.org/our-impact/80-in-every-community/#:~:text=80%25%20in%20Every%20Community%20is,in%20communities%20across%20the%20nation.

ACKNOWLEDGEMENTS

We would like to thank Aurora Mariani, MD and her team for the opportunity to collaborate and for their support of this project.

The mission and aim of this quality improvement (QI) project was to identify root causes for low CRC screening rates and test possible interventions to improve the screening rates within this population.

Electronic chart reviews for 388 eligible HMSA patients, who were overdue for CRC screening, at this primary care clinic were conducted.

Patients were included in the study if they were deemed to be at average risk for CRC, and excluded if they were high risk.

The practice’s primary care team was observed and interviewed to understand current workflows for both patient in-reach and outreach.

Conducted 3 PDSA (Plan-Do-Study–Act) cycles over 2 months to target the most common root causes.

PDSA Cycle 1: Standardized electronic orders for the Fecal Immunochemical Test (FIT).
PDSA Cycle 2: HIPAA-compliant text-messaging outreach tool to notify patients due for CRC screening.
PDSA Cycle 3: Calling patients who could not be reached via text.
Chart reviews were conducted throughout all PDSA cycles to measure changes in screening rates.

CONCLUSION

At the end of the PDSA cycles, 30 patients had picked up a kit and were planning to complete screening.

CRC information sheets and formatted text messages reminders to encourage patients to complete screening were given to the office staff to encourage continued implementation of the workflows used during the PDSA cycle.

A combination of correcting EHR and insurance claims discrepancies, standardizing workflow, and patient text and call outreach increased CRC screening rates from 45% to 64%.

METHODS

Figure 2: Pareto chart for root causes of incomplete CRC screening

Figure 1: CRC Screening Process Map

Figure 3: Run chart of CRC screening

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