Reaching 80% — How Geisinger is working to improve colorectal cancer screening

Colorectal cancer (CRC) is the third most common cancer in the US and the second most common cause of cancer-related deaths1, yet it is largely preventable if caught early through preventive screening measures.

Improving CRC screening rates was the subject of a July 22 webinar hosted by Becker's Hospital Review and sponsored by Exact Sciences.

The speaker was:

  • Nicole Trieste, RN, MBA, Director of Ambulatory Care Gaps and Best Practices at Geisinger Health Systems in Danville, PA

Here are four key takeaways from the webinar:

1. A preventable problem. Geisinger committed to screening 80 percent of its patient population for CRC. "No one should ever die of CRC, because if you screen early enough, nine times out of 10 it can be treated successfully," Ms. Trieste said. In 2017, the national average of CRC incidence rate was 38.7 per every 100,000 people. In Pennsylvania, the rate was 41.9 per every 100,000 people. Mortality rates, too, were higher than the national average of 14.2 per 100,000 people at 15.3 per 100,000 people.2 The health system had work to do, Ms. Trieste said.

2. Barriers to screening. Geisinger identified several barriers to CRC screening and developed strategies to overcome them. Patient and system-wide barriers, like colonoscopy prep, cost and lack of awareness about screening alternatives to colonoscopy, are common throughout the industry but would need to be addressed to hit its goal. Geisinger used a patient-provider partnership based around patient outreach and health information technology (HIT) optimization to do this.

3. Making strides. The health system has employed several methods to discuss and schedule CRC screenings with patients. The first method is based in the electronic medical record (EHR), and employs best practices. When a nurse begins a prescreening, the hospital's anticipatory management program alerts clinicians to care pathways. During the screening conversation, prompts appear to have nurses talk to patients about chronic diseases and schedule patients for preventive screenings. "[We are] optimizing our technology and building in those automated tools to help our providers be more efficient," Ms. Trieste said. "These tools help our providers and staff engage in the shared decision-making process." Geisinger primary care providers have many options to screen patients including colonoscopy, multi-target stool DNA (mt-sDNA) test, and fecal immunochemical (FIT) testing, and clinicians work to find a method they are comfortable with.

The partnership doesn't end when the patient leaves the office either. The system created an outreach program based on patient age and chronic disease status that sends out customizable form letters urging patients to seek care. The system's outreach team then follows-up with patients that either haven't responded to the letters or missed a screening appointment to help the patient past the screening finish line.

4. Hitting the 80 percent threshold. From June 2019 to June 2020, Geisinger increased its screening rates 3.3 percent to 69.2 percent, and regularly averages around 70 percent. Despite the initiatives, more work needs to be done, and it will take everyone in the system to reach the 80 percent threshold. "Accountability is key," Ms. Trieste said. "... There is no 'I' in team. Everyone on the team plays a part in this. From the care staff [reaching out] to patients, to the patient coming in, to the nurse [and physician] addressing the alerts. … This is a huge joint effort. There's not one person that is responsible for CRC screening in our health system."

View a copy of the webinar here, and learn more about Exact Sciences here.



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