Quality Improvement Update: Colorectal Cancer Screening Improvements
In our Spring 2019 newsletter, we introduced the Quality Improvement (QI) Department and their work to meet departmental goals coinciding with San Francisco Health Plan’s Practice Improvement Program priority metrics and Uniform Data System (UDS) metrics, a standardized reporting system used by federally qualified health centers (FQHC) across the nation.
As part of our QI initiative, MNHC has collaborated since late 2017 with the American Cancer Society and the San Francisco Cancer Initiative (SFCAN). SFCAN is a collaborative effort initiated by the UCSF Helen Diller Family Comprehensive Cancer Center to engage health care systems, government, and community groups throughout San Francisco to reduce cancer across the city and beyond. Colorectal cancer is the second leading cause of death in United States and in San Francisco. To enhance early detection, the recommendation is for patients over age 50 to get a yearly fecal immunochemical test (FIT) and if positive, referral for colonoscopy. Patients who prefer colonoscopies to FIT tests are recommended to get tested every 10 years.
We are happy to report our colorectal cancer screening rates improved! Overall, MNHC’s rate of colorectal screening rate increased 12% between Q4 2017 to Q3 2019 from 44% to 56%. Although it’s shy of the 70% goal set out by Healthy People 2020, it demonstrates significant behavioral changes and awareness in MNHC staff to move towards the national goal.
Using data analytics and chart preparation protocols to flag patients due for services, the primary care at our Shotwell and Excelsior clinics started to see an uptick in screening rates. During medical visits, Medical Assistants (MA) reminded patients that testing is due. Staff sent birthday cards to patients turning age 50 reminding them that their colon is turning 50, too, and urging them to get tested.
Some physical reminders in the clinic for MAs included care maintenance alert reminder cards for every exam room and MA computer station.
The Resource Center approach differed in that its population posed unique challenges. Individuals experiencing homelessness/vulnerable housing in San Francisco face significant structural, social, environmental and socioeconomic barriers to care. An identified barrier was that FIT kits could be lost or stolen, subjected to weather elements, or the patients would have no bathroom or privacy to complete the test and a possible delay in turning them in to staff to test.
To combat some of these barriers, staff implemented a campaign called “Poop on Demand”. Staff offer to keep the FIT test at the clinic for the patient to come back anytime. Patients use the clinic restroom to perform the test, with assistance from a MA. These activities are working; to date the Resource Center has seen an 18% rise in colorectal cancer screening rates.
“We made headway on our goal for employees to get involved in QI to improve metrics, and to be aware of their department’s QI goals and progress,” said Lauren. “We still focus on strengthening QI skills, training staff on how to track the metrics, and develop new habits to help patients get up-to-date on cancer screenings and chronic condition care.”
Next steps are to expand and increase training on QI for staff, including in-service trainings about cultural nuances and how to speak with patients about testing, more word-less instructions using pictures and a list of Frequently Asked Questions are on deck. In the future, there is a goal to link QI metrics to employee performance evaluations.
“We are pleased with the results so far,” said Lauren. “We want QI initiatives to become routine for all staff.”
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