By guest blogger Frank Colangelo, MD, FACP
Internist and Director of Quality Improvement for Premier Medical Associates, an affiliate of the Allegheny Health Network in Pittsburgh, Pennsylvania
I am a physician at Premier Medical Associates in the eastern suburbs of Pittsburgh. We are a multi-specialty group with 100 providers. Each of our seven adult primary care offices has embraced the patient-centered medical home concept. This means we practice a team-based approach to medicine that is comprehensive, continuous, and centered on patient needs.
One of the most difficult tasks I face is convincing reluctant patients to be screened for colorectal cancer. Many patients do not fully understand the prevalence of this disease or the benefits of timely screenings.
I became a very strong champion for colorectal cancer screening several years ago after one of my patients died from this terrible disease in his early 50s. Despite my advice at every annual visit to complete some form of colorectal cancer screening, he did not comply.
Of cancers that affect both men and women, colorectal cancer is the second leading cause of cancer-related deaths in the United States. Both men and women are affected by this disease. About 50,000 people die from colorectal cancer each year.
Most people who need to be screened are between the ages of 50 and 75. The United States Preventive Services Task Force recommends either a colonoscopy every 10 years, a flexible sigmoidoscopy every five years in combination with a high-sensitivity stool test (fecal occult blood test or fecal immunochemical test) every three years, or a high-sensitivity stool test every year. For patients who are not at high risk for colorectal cancer, stool tests are easy to use and can be done discreetly at home.
Many studies have shown it is more likely that patients will get screened for colorectal cancer if their doctors recommend it. A few years ago, I attended a lecture where I heard Richard Wender, MD, chair of the National Colorectal Cancer Roundtable and Chief Cancer Control Officer of the American Cancer Society, talk about CDC’s Colorectal Cancer Control Program. One of its goals is to increase colorectal cancer screening rates for adults aged 50–75 years to 80% by the end of 2014 among funded states.
As a participating provider with the Pennsylvania Colorectal Cancer Control Program, I worked with the state health department to invite Dr. Wender to our practice, where he gave an impassioned talk about each practice’s responsibility to work as a team to improve screening rates. Our practice kicked off this effort in December 2012. At the time, our screening rates were very close to the national screening rates (in the low 60% range).
We began to make changes. I realized that the patient registry function of our electronic health record system could help us. Our organization worked to make sure that every patient’s colon cancer screening information was captured so it could be tracked. For every patient visit (not just at preventive physical exam visits), I encouraged each provider and staff member to use the registry function to look for patients who had not been screened so they could recommend screening to these patients. To help answer questions, every exam room was stocked with copies of the Colorectal Cancer Screening Saves Lives [PDF-2.6MB] brochures provided by CDC’s Screen for Life: National Colorectal Cancer Action Campaign.
We also used the registry function to identify patients who required or will require specific outreach efforts. Patients who were screened but fell behind on follow-up testing were contacted. Patients whose FIT results were positive were monitored closely to ensure that they had a follow-up colonoscopy. Every doctor gets a monthly report card with each panel’s percentage-to-be-screened rate.
Finally, we compiled a list of patients who had never been screened. In conjunction with March’s National Colorectal Cancer Awareness Month observance, we are sending a letter to each person, educating them about the importance of screening.
My practice cares for about 17,000 patients who need to be screened for colorectal cancer. We are closing in on the 75% screened mark, and are using many resources to reach the 80% goal by the end of 2014. I am confident that these efforts will prevent deaths from this disease. My practice is proof that we can increase screening. I challenge other medical practices to commit to increasing colorectal cancer screening rates, and saving more lives from this largely preventable disease.