Closed Loop Cancer Screening Tests Ordered during Primary Care Visits for High-Risk Patients
Project Lead: Matt Germak, MD, MPH
Project AIM(s):
- Primary goal = increase by 25% completion of cancer screening tests during intervention period
- Secondary goal = improve primary care providers’ ability to address any social determinants of health (SDOH) needs identified by the Community Health Navigator that may impact cancer screening test loop closure.
The primary aim of our project was to increase completion of cancer screening tests during the intervention period by 25%. Our analysis determined a statistically significant 3.6 percentage point increase between our intervention group and our control group (p=0.03). This is an 11.25% increase in cancer screening test completion. Although short of our aim, we are encouraged by the results.
Our secondary aim was to improve primary care providers’ ability to address any social determinants of health (SDOH) needs identified by the Community Health Navigator that may impact cancer screening test loop closure. 433 patients were screened for SDOH during the intervention period and 23 screened positive.
Narrative Description:
Our project was limited in access to data at the patient’s chosen screening location. Because there are many locations both within and outside of our health system at which a patient could schedule their screening test, understanding which patients had and had not completed their test was challenging at times. We found it was still valuable to outreach patients who had scheduled their tests so that we could conduct an SDOH screening for any barriers that might prevent them from completing the test. In the end, only 68 patients (9.8%) we made contact with had already scheduled their test.
As a large primary care system, it can at times be a challenge to coordinate with the frontline primary care team. Because the Community Health Navigator (CHN) outreach was centralized, the care teams did not always know that the CHN was doing outreach. We socialized our work and model at various team meetings within the system and documented all patient interactions to ensure care team members were aware of our activities.
Our key finding is demonstrating that a CHN model can help close the loop on cancer screening test completion and lead to increased completion of cancer screening tests.
Our project found that a CHN model increased cancer screening completion rates by 3.6 percentage points compared to a control group. The benefits of the intervention include: reducing delays in cancer diagnosis, decreased malpractice risk, and improved patient care. Our project impacted 54 patients who may not have otherwise completed their cancer screening test. To be even more effective in the future, we would like to further target our intervention to the patients who need this support most.
Diagnostic quality problem type, failure, or category (symptoms, observed problems, gaps in performance) addressed by the intervention
- Patient delayed or unable to access to care
- Information gathering
- Information integration
- Information interpretation
- Establishing an explanation (diagnosis)
Root causes/causative factors addressed by the intervention
- Patient-clinician interaction (includes patient and family engagement)
- Workflow (includes testing, follow-up, and referrals)
- Health information sharing and accessibility via health IT
- Knowledge gaps/inexperience
Setting of the diagnostic quality improvement intervention
- Ambulatory medical care setting (e.g., clinic, office, urgent care)