Schiff Gordon D, Bearden Trudy, Hunt Lindsay Swain, Azzara Jennifer, Larmon Jay, Phillips Russell S, Singer Sara, Bennett Brandon, Sugarman Jonathan R, Bitton Asaf, Ellner Andrew
Jt Comm J Qual Patient Saf. 2017 Jul;43(7):338-350. doi: 10.1016/j.jcjq.2017.03.004. Epub 2017 Apr 19.
Colorectal cancer (CRC) is a leading cause of cancer death, reducible by screening and early diagnosis, yet many patients fail to receive recommended screening. As part of an academic improvement collaborative, 25 primary care practices worked to improve CRC screening and diagnosis.
The project featured triannual learning sessions, monthly conference calls, practice coach support, and monthly reporting. The project phases included literature review and interviews with national leaders/organizations, development of driver diagrams to identify key factors and change ideas, project launch and practice team planning, and a practice improvement phase.
The project activities included (1) inventory of barriers and best practices, (2) driver diagram to drive improvements, (3) list of changes to try, (4) compilation of lessons learned, and (5) five key changes to optimize screening and follow-up. Practices leveraged prior transformation efforts to track patients for screening and follow-up during and between office visits. By mapping processes, testing changes, and collecting data, sites targeted opportunities to improve quality, safety, efficiency, and patient and care team experience. Successful change interventions centered around partnering with gastroenterology, engaging leadership, leveraging registries and health information technology, promoting alternative screening options, and partnering with and supporting patients. Several practices achieved improvement in screening rates, while others demonstrated no change from baseline during the 10-month testing and implementation phase (July 2014-April 2015).
The collaborative effectively engaged teams in a broad set of process improvements with key lessons learned related to barriers, information technology challenges, outreach challenges/strategies, and importance of stakeholder and patient engagement.
结直肠癌（CRC）是癌症死亡的主要原因之一，通过筛查和早期诊断可降低死亡率，但许多患者未能接受推荐的筛查。作为学术改进合作项目的一部分，25家基层医疗诊所致力于改善CRC筛查和诊断。
该项目包括每三个月一次的学习会议、每月一次的电话会议、实践指导支持以及每月报告。项目阶段包括文献综述和对国家领导人/组织的访谈、绘制驱动图以确定关键因素和变革想法、项目启动及实践团队规划，以及实践改进阶段。
项目活动包括（1）障碍和最佳实践的盘点，（2）推动改进的驱动图，（3）尝试变革的清单，（4）经验教训的汇编，以及（5）优化筛查和随访的五项关键变革。各诊所利用先前的转型努力在就诊期间和就诊间隔期跟踪患者进行筛查和随访。通过绘制流程、测试变革和收集数据，各站点确定了提高质量、安全性、效率以及患者和护理团队体验的机会。成功的变革干预措施围绕与胃肠病学合作、吸引领导层参与、利用登记册和健康信息技术、推广替代筛查选项以及与患者合作并为其提供支持展开。几家诊所的筛查率有所提高，而其他诊所在10个月的测试和实施阶段（2014年7月至2015年4月）与基线相比无变化。
该合作有效地促使团队进行了一系列广泛的流程改进，并获得了与障碍、信息技术挑战、外展挑战/策略以及利益相关者和患者参与的重要性相关的关键经验教训。
