Colorectal cancer risk assessment in rural primary care: a quality improvement project

Abstract

Background: Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality in the United States. Early-onset CRC among individuals under 50 years is increasing, while screening rates remain below national targets. Rural populations experience additional disparities due to limited healthcare access, lower preventative care utilization, and reduced screening rates. Local Problem: At a rural primary care clinic in north central Montana, only 27% of eligible patients were current with colorectal cancer screenings (CRCS). A new electronic health record further limited providers' ability to identify patients due for screening. Methods: This quality improvement project utilized the Institute for Healthcare Improvement framework to implement a structured colorectal cancer (CRC) risk assessment process based on American Cancer Society guidelines. Adult patients aged 21-75 presenting for annual wellness or establish-care visits during a six-week implementation period received a CRC risk assessment form at registration. Completed assessments were used to inform individualized screening recommendations. Project outcomes were evaluated using descriptive statistics. Results: All full-time staff (n=3, 100%) completed pre-implementation education. Of 33 eligible patients, 25 of the 33 (75.7%) completed the risk assessment form. Nine patients out of the 25 (36%) were identified as needing screening; screening orders were placed for three patients of those nine patients (33%). Conclusion: Implementing a structured CRC risk assessment in a rural primary care setting was feasible and improved the identification of patients needing screening. Integrating risk assessment into routine clinic workflow may support earlier identification of at-risk individuals and help address persistent colorectal cancer screening disparities in rural populations.