A Multi-Level Fit-Based Quality Improvement Initiative to Improve Colorectal Cancer Screening in a Managed Care Population.

IntroductionColorectal cancer (CRC) is a common but largely preventable disease with suboptimal screening rates despite national guidelines to screen individuals age 50-75. Single-component interventions aimed to improve screening uptake only modestly improve rates; data suggest that multi-modal approaches may be more effective.MethodsWe designed, implemented, and evaluated the impact of a multi-modal intervention on CRC screening uptake among unscreened patients in a large managed care population. Patient-level components included a mailed letter with education about screening options and pre-colonoscopy telephone counseling. For providers, we facilitated communication of screening test results and work-flow for abnormal results. System-level modifications included establishment of a patient navigator, expedited work-up for abnormal results, and stream-lined colonoscopy scheduling. We measured the rate of screening uptake overall, screening uptake by modality, change in the proportion of the population screened, and positive fecal immunochemical test (FIT) follow-up rates in the 1-year study period.ResultsThere were 5093 patients in the intervention cohort. Of these, 33.2% participated in FIT or colonoscopy screening within 1 year of the mailing. A total of 1078 (21.2%) participants completed a FIT and 611 (12.0%) completed a screening colonoscopy. The screening rate in the managed care population increased from 65.1 to 76.6%. Fifty-nine patients (5.5%) had a positive FIT, of which 30 (50.8%) completed a diagnostic colonoscopy.ConclusionMulti-modal interventions can result in substantial improvement in CRC screening uptake in large and diverse managed care populations.Translational impactHealth systems should shift their focus from single-level to multi-level interventions when addressing barriers to CRC screening

Value-Based Health Care for Inflammatory Bowel Diseases

Cellular mechanisms in basic and clinical gastroenterology and hepatolog

A Nationwide 2010-2012 Analysis of U.S. Health Care Utilization in Inflammatory Bowel Diseases

Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Development and Validation of an Inflammatory Bowel Diseases Monitoring Index for Use With Mobile Health Technologies

Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Understanding Cardiac Anatomy and Imaging to Improve Safety of Procedures: The Sinus Node Artery.

The sinus node artery can originate from either the right or the left coronary arteries, or even both, and follows a variable course. Being aware of these important variations is of clinical significance during open heart surgery and catheter ablation procedures to avoid injury to the artery