Improvement of colorectal cancer screening in a primary care setting: a quality improvement project

Abstract

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States. Evidence-based screening plays a critical role in early detection and mortality reduction. Despite established guidelines and at-home stool-based screening options, completion rates remain inconsistent. Local Problem: A primary care clinic in southwest Montana identified inconsistent follow-up and documentation of overdue tests, resulting in missed opportunities for screening. No standardized processes for reminder outreach or documentation were in place or consistently utilized prior to the intervention. Methods: This quality improvement (QI) project was conducted over eight weeks using two four-week Plan-Do-Study-Act cycles. Participants included clinical staff and adult patients with an ordered test during the implementation period (n = 19). Outcome measures included staff education completion, delivery of reminder outreach, utilization of smart-phrase documentation, screening completion, and overall clinic CRC screening rates. Intervention: The intervention included staff education on a revised workflow, structured patient reminder outreach [phone or electronic messaging], and implementation of a standardized smart-phrase for documentation. Results: 100% of the clinical staff participated in the workflow education session. Outreach reminders were delivered to 53% of eligible patients, and smart-phrase documentation was utilized in 60% of applicable charts. Among patients receiving reminders, 70% completed screening, and the clinic's reported CRC screening rate improved from 70% to 76%. Conclusion: Implementation of a structured workflow was associated with improved CRC screening completion rates. Proactive, reminder-based strategies may support preventive screening processes in primary care, highlighting the importance of consistent implementation and team engagement in QI efforts.