Improvement in colon cancer screening through use of a multilevel intervention: A QI initiative

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Background and purpose:

Colon cancer is the second leading cause of cancer-related deaths in the United States but is highly treatable when diagnosed early. The purpose of this quality improvement (QI) initiative was to develop, implement, and evaluate a multilevel intervention to raise colon cancer screening rates.


A pre- and postintervention design was used with patients who were largely Caucasian and English speaking. Patients were mailed information about the importance of screening, and a phone line was created for patients to select a colonoscopy, fecal immunochemical test, or decline screening. Patients not responding via the phone line received an e-mail or postcard about the importance of screening. Electronic flags were sent to providers on the day of the visit to remind staff to address screening. Uninsured patients received free screening.


Across three clinics, colon cancer screening rates increased by 6.3%–6.9% through use of a multilevel intervention. Staff satisfaction was moderately high for ease of use, staff education, and perceived success of the QI initiative.

Implications for practice:

Patient education, decision support tools, outreach to patients by mail, phone, e-mail, electronic flags, and free screening for uninsured patients collectively can increase colon cancer screening rates in an at-risk population.

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