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Increasing colorectal cancer screening orders using unlicensed assistive personnel
  1. Kanako Ishida,
  2. Erin Weiss,
  3. Summer A Kee,
  4. Charles T Yingling
  1. College of Nursing-Health Systems Science, University of Illinois at Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Charles T Yingling; cyingl1{at}


Background Colorectal cancer (CRC) is among the leading cancer diagnoses affecting both men and women worldwide. Prevention and early detection of CRC is possible by increasing access to and utilisation of screening tests. Although CRC screening is highly recommended, screening rates remain suboptimal in the USA, particularly among underserved populations. Our project site, an urban federally qualified health centre, was not meeting the national screening target of 80% of eligible adults.

Objective The aim of this quality improvement project was to increase the number of orders for CRC screening to eligible patients by using unlicensed assistive personnel and automated telephone outreach calls to offer 100 patients CRC screening during an 8-week period.

Methods 40 patients received outreach calls from care coordinators (CC). 40 patients received automated telephone call reminders to call a CC to obtain an order for CRC screening. 20 patients were offered CRC screening by a medical assistant (MA) as part of their scheduled office visits. We used two plan-do-study-act (PDSA) cycles to deliver these three screening interventions.

Results A total of 100 patients received one of the interventions. Ten of those patients received an order for either colonoscopy or faecal immunochemical testing by the conclusion of the second PDSA cycle. The MA-offered screening resulted in the highest percentage of patients accepting CRC screenings and patients preferred this outreach approach compared with CC outreach or automated voice messages. CC outreach yielded a lower rate of accepted screenings. None of the patients who received the automated calls followed up to obtain a screening order.

Conclusion Our project demonstrates that unlicensed assistive personnel have the potential to increase patient access to CRC screening.

  • cost-effectiveness
  • healthcare quality improvement
  • primary care
  • quality improvement

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  • Contributors KI, SAK, EW and CTY designed, implemented and evaluated the QI programme presented in this manuscript. KI and CTY prepared the manuscript for publication with input from EW and SAK. All authors reviewed and approved the final manuscript submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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