About the Project
The goal of the Improving Cancer Early Detection in Primary Care Project was to move toward reduction in the burden of cancer by promoting the early detection and follow up of breast, cervical and colorectal cancers.

In this project, the Michigan Department of Community Health and the Michigan Public Health Institute funded five health systems (grantees) to improve the health systems' cancer early detection processes in their primary care practices.

This called for grantees to work within selected primary care practices (pilot sites) to develop or improve continuous quality improvement (CQI) processes within the pilot site or the health system. Grantees were charged specifically with improving cancer early detection through the use of a CQI process. CQI is a systematic step-wise cycle for organizational improvement, and includes assessment, planning, implementation, and evaluation phases.

Grantees were required to:

• develop sustainable strategies to improve both cancer screening rates as well as responses to follow up of abnormal findings;
  
• reduce the number of missed opportunities for cancer early detection;
  
• build systems to facilitate screening; and
  
• address barriers to breast, cervical and colorectal cancer screening for patients, providers and systems of care.

To accomplish these aims, the grantees were to assist in design, development, implementation and evaluation of any and all strategies that the pilot sites deemed useful. These strategies or interventions were developed based on data (such as screening rates, consumer survey data, focus group data), tools (such as process flow diagrams), and apparent barriers.

The grantees all conducted varied and multiple interventions designed to impact patient, provider and system barriers. The interventions were tailored to sites’ needs and values, rather than being imposed upon the sites.

Results
All of the grantees reported improved cancer early detection rates post-intervention, and improved screening processes or systems. At post-intervention, one grantee had all its pilot sites meeting the MCC priorities for (breast, cervical and colorectal) cancer early detection.

All grantees were able to identify barriers to reduction of missed opportunities, and to address these in interventions. Interventions addressed missed opportunities by focusing on consistent use of guidelines, changes to reminder and tracking systems, chart organization, electronic monitoring, and patient tools. Interventions addressed follow up to abnormal results when they focused on continuity of care, chart tools, and reminder and tracking.

Lessons Learned
Institutions not only can address cancer early detection using a CQI model, but also can learn to anticipate and avoid obstacles. Assessing a health care system’s readiness to change is part of this challenge. The organizational capacity of the practice to engage in CQI needs to be understood prior to deciding that CQI is the best approach to institutional early detection goals. One can assess the practice’s state of readiness to engage in CQI in part by asking whether practices see CQI as relevant, fitting within daily routines, value-added, sustainable, and a good use of staff time.

Readiness to engage in a CQI process to create change is also demonstrated in part by whether the health care system has made a commitment to adopting and promoting cancer early detection consensus guidelines and to allocate staff time for CQI team participation. The guidelines should be the basis for the development of the CQI process and for determining whether cancer early detection rates have changed.

To Learn More
For more information, read the project summary report (available as an Adobe Acrobat PDF file)* or contact Susan Affholter of the Michigan Department of Community Health Cancer Prevention & Control Section at 517-335-9349, e-mail: affholtersu@michigan.gov).

*Please Note: You will need Adobe Acrobat Reader to open, view and print this file once it has been downloaded. If you need a free copy of Adobe Acrobat Reader, please click here.

last updated: 10/24/05

Washington Square Building, 5th Floor · 109 Michigan Ave. · Lansing, Michigan USA 48913 Toll-Free: (877) 588-6224 · Fax: (517) 335-9397 ·