Impact of a generalizable reminder system on colorectal cancer screening in diverse primary care practices: a report from the prompting and reminding at encounters for prevention project

Med Care. 2008 Sep;46(9 Suppl 1):S68-73. doi: 10.1097/MLR.0b013e31817c60d7.

Abstract

Background: Computerized reminder systems (CRS) show promise for increasing preventive services such as colorectal cancer (CRC) screening. However, prior research has not evaluated a generalizable CRS across diverse, community primary care practices. We evaluated whether a generalizable CRS, ClinfoTracker, could improve screening rates for CRC in diverse primary care practices.

Methods: The study was a prospective trial to evaluate ClinfoTracker using historical control data in 12 Great Lakes Research In Practice Network community-based, primary care practices distributed from Southeast to Upper Peninsula Michigan. Our outcome measures were pre- and post-study practice-level CRC screening rates among patients seen during the 9-month study period. Ability to maintain the CRS was measured by days of reminder printing. Field notes were used to examine each practice's cohesion and technology capabilities.

Results: All but one practice increased their CRC screening rates, ranging from 3.3% to 16.8% improvement. t tests adjusted for within practice correlation showed improvement in screening rates across all 12 practices, from 41.7% to 50.9%, P = 0.002. Technology capabilities impacted printing days (74% for high technology vs. 45% for low technology practices, P = 0.01), and cohesion demonstrated an impact trend for screening (15.3% rate change for high cohesion vs. 7.9% for low cohesion practices).

Conclusions: Implementing a generalizable CRS in diverse primary care practices yielded significant improvements in CRC screening rates. Technology capabilities are important in maintaining the system, but practice cohesion may have a greater influence on screening rates. This work has important implications for practices implementing reminder systems.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / prevention & control
  • Female
  • Humans
  • Male
  • Mass Screening / statistics & numerical data*
  • Michigan
  • Middle Aged
  • Patient Compliance / statistics & numerical data
  • Practice Patterns, Physicians' / statistics & numerical data
  • Primary Health Care / methods*
  • Primary Health Care / statistics & numerical data
  • Prospective Studies
  • Quality Assurance, Health Care
  • Reminder Systems*
  • Research Design
  • Social Support