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01-07-2015 | Original Article

Building Equity Improvement into Quality Improvement: Reducing Socioeconomic Disparities in Colorectal Cancer Screening as Part of Population Health Management

Authors: Seth A. Berkowitz, MD MPH, Sanja Percac-Lima, MD PhD, Jeffrey M. Ashburner, , MPH, Yuchiao Chang, PhD, Adrian H. Zai, MD PhD MPH, Wei He, MS, Richard W. Grant, MD MPH, Steven J. Atlas, MD MPH

Published in: Journal of General Internal Medicine | Issue 7/2015

ABSTRACT

BACKGROUND

Improving colorectal cancer (CRC) screening rates for patients from socioeconomically disadvantaged backgrounds is a recognized public health priority.

OBJECTIVE

Our aim was to determine if implementation of a system-wide screening intervention could reduce disparities in the setting of improved overall screening rates.

DESIGN

This was an interrupted time series (ITS) analysis before and after a population management intervention.

PARTICIPANTS

Patients eligible for CRC screening (age 52–75 years without prior total colectomy) in an 18-practice research network from 15 June 2009 to 15 June 2012 participated in the study.

INTERVENTION

The Technology for Optimizing Population Care (TopCare) intervention electronically identified patients overdue for screening and facilitated contact by letter or telephone scheduler, with or without physician involvement. Patients identified by algorithm as high risk for non-completion entered into intensive patient navigation.

MAIN MEASURES

Patients were dichotomized as ≤ high school diploma (≤ HS), an indicator of socioeconomic disadvantage, vs. >HS diploma (> HS). The monthly disparity between ≤ HS and > HS with regard to CRC screening completion was examined.

KEY RESULTS

At baseline, 72 % of 47,447 eligible patients had completed screening, compared with 75 % of 51,442 eligible patients at the end of follow-up (p < 0.001). CRC screening completion was lower in ≤ HS vs. >HS patients in June 2009 (65.7 % vs. 74.5 %, p < 0.001) and remained lower in June 2012 (69.4 % vs. 76.7 %, p < 0.001). In the ITS analysis, which accounts for secular trends, TopCare was associated with a significant decrease in the CRC screening disparity (0.7 %, p < 0.001). The effect of TopCare represents approximately 99 additional ≤ HS patients screened above prevailing trends, or 26 life-years gained had these patients remained unscreened.

CONCLUSIONS

A multifaceted population management intervention sensitive to the needs of vulnerable patients modestly narrowed disparities in CRC screening, while also increasing overall screening rates. Embedding interventions for vulnerable patients within larger population management systems represents an effective approach to increasing overall quality of care while also decreasing disparities.

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Title: Building Equity Improvement into Quality Improvement: Reducing Socioeconomic Disparities in Colorectal Cancer Screening as Part of Population Health Management
Authors: Seth A. Berkowitz, MD MPH
Sanja Percac-Lima, MD PhD
Jeffrey M. Ashburner, , MPH
Yuchiao Chang, PhD
Adrian H. Zai, MD PhD MPH
Wei He, MS
Richard W. Grant, MD MPH
Steven J. Atlas, MD MPH
Publication date: 01-07-2015
Publisher: Springer US
Published in: Journal of General Internal Medicine / Issue 7/2015
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-015-3227-4

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ABSTRACT

BACKGROUND

OBJECTIVE

DESIGN

PARTICIPANTS

INTERVENTION

MAIN MEASURES

KEY RESULTS

CONCLUSIONS

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