Article Figures & Data
Figures
- Figure 1.
Flow diagram for patient eligibility and participation in Multi-component colorectal cancer (CRC) screening study March–May, 2020.
- Figure 2.
Stool-based CRC screening ordered and completed by month 2020 in a rural family medicine clinic.
- Figure 3.
Colorectal cancer screening for clinic and health system by month 2019 and 2020.
Tables
- Table 1.
Multi-Component CRC Screening Intervention in Rural Family Medicine Clinic March–May 2020
Interventions to increase provider delivery of screening services - Surveyed “exemplar” providers in our health system to identify their best practices
- Academic detailing of all clinic providers
- Providers dedicating time each week to panel management
- Each provider audited monthly and received a statement about their individual CRC screening rates
- Overall clinic CRC screening rates were posted and updated monthly on a white board inside the staff clinic entrance
Interventions to increase community demand - Follow up phone call and letter to each patient at 1- and 2-months post MT-sDNA order
- Staff and clinicians wore CRC awareness ribbons
- CRC informational posters and brochures (small media) were originally planned for clinic waiting areas but removed due to COVID-19 infectious disease control measures
Interventions to increase community access - Prioritization of use of mailed MT-sDNA tests rather than colonoscopy/ sigmoidoscopy
- Phone call from provider to overdue patients recommending CRC screening and offering MT-sDNA screening
- One staff designated for patient follow up and navigation on all MT-sDNA orders
Abbreviation: CRC, colorectal cancer.
- Table 2.
Demographic Characteristics of Multi-Component Study Sample and County-Wide Population March 2020
Demographic Category Study Sample Percentages County-Wide Percentages* Average age 63.3 40 Gender Man 45.2 54.1 Woman 54.1 45.9 Location of Residence Urban 0.7 0 Small town/Suburb 44.4 49.1 Rural 54.8 50.9 Ethnicity White 97.8 84.8 Black/African American 0 6.4 Hispanic 1.5 6.8 Other 0.7 2.0 Education Elementary/Junior high only 1.5 10.5 High school 42.6 41.3 College/Vocational training 42.6 42.8 Graduate/Professional degree 13.2 5.4 Socioeconomic status Lower 28.7 46 Middle 64.3 51 Upper 7 3 Smoker Yes 20.9 22.1 No 79.1 77.9 Primary care provider Yes 97.8 83.6 No 2.2 16.4 ↵Notes. *Based on U.S. Census county population data.
- Table 3.
Clinic Stool-Based CRC Screening Orders per Week Compared with Other Health Systems Pre and Post Initial COVID-19 Surge, 2020
Study Stool-Based Screen/Week Pre Stool-Based Screen/Week Post Paired-Sample t Test One-Sample t Test % Change in CRC Screening Klugas et al. 2023 1 16 t = 10.95*** ---------- 94% more Gorina et al. 2021 210 51 ---------- t = 2719*** 75% less Patel et al. 2020 370 60 ---------- t = 5286*** 83% less Myint et al. 2021 154 60 ---------- t = 1614*** 61% less ↵Notes: aClinic’s regional health system. ***P = <0.01.
Abbreviation: CRC, colorectal cancer.
- Table 4.
Strengths and Limitations of Our Multi-Component Intervention to Increase CRC Screening Rates in a Rural Family Medicine Clinic During Initial COVID-19 Surge, 2020
Strengths Our survey of exemplar28 providers’ strategies for achieving higher CRC screening rates lends qualitative support to our intervention strategy We used a multi-component intervention strategy in line with Community Preventive Service Task Force recommendations We attempted to “control” our study by comparing our intervention clinic data with regional and national outcomes as well as our own clinic data from year before the pandemic The fact that our CRC screening rates increased during a time when rates were decreasing regionally,25 nationally26,27 and internationally24 adds evidence that our intervention had an impact Limitations Inability to differentiate the individual contribution of each component of our intervention to the overall treatment effect Our study may be more subject to effects of confounding variables due to the lack of randomized, controlled design Based on our self-reported demographics, persons of color and persons without a primary care provider may be under represented in our results Our results based on one, rural Midwest clinic may limit external validity and generalizability Abbreviation: CRC, colorectal cancer.
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