INCREASING COLORECTAL CANCER SCREENING

描述(由申请人提供)： 这项提案考察了电子提醒系统和医生教育计划在一个大型初级保健医生网络--犹他大学社区诊所--中提高结肠癌筛查率的有效性。我们将：1)在网络中实施第二代电子提示系统，以及患者护理系统的变化，以最大限度地发挥这种提示的有效性；2)为网络医生制定关于结肠癌筛查的全面教育计划；然后，3)将结果筛查率与网络中的预研筛查率以及从几个来源确定的社区筛查率进行比较。研究背景包括50多名初级保健医生和20名中层提供者，他们通过电子病历(EMR)在一个六家诊所的初级保健网络中建立联系。该网络为犹他州盐湖城及其周边地区的10万多名不同人口和种族背景的患者提供护理。该项目的一个主要特点将是实施一个计算机化的提醒系统，促使临床医生向适当的患者提供CRC筛查，然后跟踪完成的所有测试的结果。提醒系统将得到关于结肠癌筛查的广泛医生教育计划的补充，以及在文化和种族多元化人口的实践环境中实施筛查。该项目被设计为一项旨在改变医生行为的质量改进(QI)调查。因此，为了支持电子提示系统，我们将对整个病人护理流程进行各种补充改革。这些变化将利用个人改进的频繁、快速循环试验的QI过程来实施，并通过统计过程控制(SPC)进行持续监测，以检测改进对CRC筛查率和结果的影响。这一方法将使在该网络中得出最佳做法的关键原则成为基础，以便在预期的后续调查中向更大范围的其他医疗做法传播这种程序改进的一揽子方案。

DESCRIPTION (provided by applicant): This proposal examines the effectiveness of an electronic reminder system and a physician education program to increase the rates of colon cancer screening in a large network of primary care physicians, the University of Utah Community Clinics. We will: 1) implement a second-generation electronic prompt system in the network together with patient care system changes to maximize the effectiveness of this prompting; 2) institute a comprehensive educational program on colon cancer screening for network physicians; and then, 3) compare resultant screening rates to pre-study rates in the network as well as to community screening rates determined from several sources. The study setting involves over 50 primary care physicians and 20 mid-level providers linked by an electronic medical record (EMR) within a six-practice primary care network. The network provides care to over 100,000 patients of diverse demographic and ethnic background in and around Salt Lake City, Utah. A central feature of the project will be implementation of a computerized reminder system that prompts clinicians to offer CRC screening to appropriate patients and then tracks the results of all tests completed. The reminder system will be complemented by an extensive physician education program on colon cancer screening as well as implementation of screening in the practice setting of a culturally and ethnically diverse population. The project is designed as a Quality Improvement (QI) investigation directed at changing physician behavior. Thus, to support the electronic prompt system, we will institute a variety of complementary changes to the overall patient care process. These changes will be implemented using the QI process of frequent, rapid-cycle trials of individual improvements, with continuous monitoring via Statistical Process Control (SPC) to detect the impact of improvements on CRC screening rates and outcomes. This approach will enable derivation of key principles of best practice in this network as a basis to disseminate a package of such process improvements to a larger group of other medical practices in anticipated follow-on investigation.