INCREASING COLORECTAL CANCER SCREENING

描述（由申请人提供）： 本提案旨在研究电子提醒系统和医师教育计划在犹他州大学社区诊所的大型初级保健医师网络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，并改变患者护理系统，以最大限度地提高这种提示的有效性; 2）为网络医生制定一项关于结肠癌筛查的综合教育计划; 3）将由此产生的筛查率与网络中的研究前比率以及从几个来源确定的社区筛查率进行比较。 该研究涉及50多名初级保健医生和20名中级提供者，他们通过电子病历（EMR）在六个实践初级保健网络中联系起来。 该网络为犹他湖城及其周边地区10万多名不同人口和种族背景的患者提供护理。 该项目的一个核心特点是实施一个计算机化的提醒系统，提示临床医生为适当的患者提供CRC筛查，然后跟踪所有完成的测试结果。 提醒系统将辅之以一个关于结肠癌筛查的广泛的医生教育计划，以及在文化和种族多样性人口的实践环境中实施筛查。该项目被设计为质量改进（QI）调查，旨在改变医生的行为。 因此，为了支持电子提示系统，我们将对整个病人护理过程进行各种补充性修改。 这些变化将通过QI流程实施，即对个体改善进行频繁、快速周期的试验，并通过统计过程控制（SPC）进行持续监测，以检测改善对CRC筛查率和结局的影响。 这一方法将有助于在该网络中得出最佳做法的主要原则，作为在预期的后续调查中向更多的其他医疗实践传播一揽子此类流程改进的基础。

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.