Marx Rani, Tse Winnie M, Golden Lisa, Johnson Elizabeth C
Primary Care (Dr Marx and Ms Tse) and Ambulatory Care (Dr Golden), San Francisco Health Network, San Francisco Department of Public Health, San Francisco, California; and Department of Family and Community Medicine, University of California San Francisco (Drs Golden and Johnson).
J Public Health Manag Pract. 2016 Sep-Oct;22(5):466-71. doi: 10.1097/PHH.0000000000000275.
Adult colorectal cancer screening (CRCS) can lower disease incidence and mortality. However, widespread implementation is inconsistent, especially in the public sector. While specific interventions to increase CRCS have been identified, firsthand accounts of CRCS improvement efforts using multiple techniques in public sector settings are lacking.
A program evaluation was conducted to assess the effect of implementing a culture of continuous quality improvement (QI) on CRCS practices and prevalence. A multipronged incremental effort over more than a decade to increase CRCS at the San Francisco Department of Public Health is described.
Community-based primary care clinics.
Departmental activities and 5 clinics providing full-scope primary care to CRCS-eligible adults who participated in departmental activities and outreach interventions were assessed.
Departmental and clinic-specific CRCS activities and prevalence.
Efforts included departmental prioritization; data-driven QI incorporating routine data sharing (monthly reports and data walls); departmental and clinic-specific QI committees; panel management (a team approach to generation of eligibility lists prior to scheduled visits, routinely offering screening during appointments or mailing test kits for patients without appointments); and departmental mail and phone outreach events. Screening ranged from 36.6% to 54.4% in 2010; in 2013, it ranged from 43.6% to 70.2%. Increases occurred consistently over that time in 3 of the 5 clinics and ranged from 1.1% to 14.5%; decreases occurred during 2 intervals in 2 clinics and ranged from 2.3% to 4.3%.
CRCS prevalence can be markedly improved in the public sector with a data-driven panel management approach supported by departmental and clinic-specific QI committees and group outreach events. Continued prioritization of and focus on CRCS is required to ensure long-term success. Even small increases will result in avoidable morbidity and mortality associated with this highly preventable disease.
成人结直肠癌筛查（CRCS）可降低疾病发病率和死亡率。然而，广泛实施情况并不一致，尤其是在公共部门。虽然已确定了增加CRCS的具体干预措施，但缺乏在公共部门环境中使用多种技术进行CRCS改进工作的第一手资料。
进行一项项目评估，以评估实施持续质量改进（QI）文化对CRCS实践和普及率的影响。描述了在十多年里旧金山公共卫生部为增加CRCS所做的多方面渐进式努力。
社区基层医疗诊所。
评估了部门活动以及为符合CRCS条件且参与部门活动和外展干预的成年人提供全面基层医疗服务的5家诊所。
部门和诊所特定的CRCS活动及普及率。
所做努力包括部门优先排序；纳入常规数据共享（月度报告和数据墙）的数据驱动QI；部门和诊所特定的QI委员会；小组管理（一种在预定就诊前生成资格名单的团队方法，在预约期间常规提供筛查或为未预约患者邮寄检测试剂盒）；以及部门邮件和电话外展活动。2010年筛查率在36.6%至54.4%之间；2013年，筛查率在43.6%至70.2%之间。在此期间，5家诊所中有3家持续上升，增幅在1.1%至14.5%之间；2家诊所出现过2次下降，降幅在2.3%至4.3%之间。
在部门和诊所特定的QI委员会以及团体外展活动支持下，采用数据驱动的小组管理方法可显著提高公共部门的CRCS普及率。要确保长期成功，需要持续对CRCS进行优先排序并予以关注。即使是小幅提高也将减少与这种高度可预防疾病相关的可避免的发病率和死亡率。
