Medical Care

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Medical Care:
doi: 10.1097/MLR.0b013e31817c60d7

Impact of a Generalizable Reminder System on Colorectal Cancer Screening in Diverse Primary Care Practices: A Report From the Prompting and Reminding at Encounters for Prevention Project

Nease, Donald E. Jr MD*; Ruffin, Mack T. IV MD, MPH*; Klinkman, Michael S. MD, MS*; Jimbo, Masahito MD, MPH*; Braun, Thomas M. PhD†; Underwood, Jennifer M. BS‡

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Background: Computerized reminder systems (CRS) show promise for increasing preventive services such as colorectal cancer (CRC) screening. However, prior research has not evaluated a generalizable CRS across diverse, community primary care practices. We evaluated whether a generalizable CRS, ClinfoTracker, could improve screening rates for CRC in diverse primary care practices.

Methods: The study was a prospective trial to evaluate ClinfoTracker using historical control data in 12 Great Lakes Research In Practice Network community-based, primary care practices distributed from Southeast to Upper Peninsula Michigan. Our outcome measures were pre- and post-study practice-level CRC screening rates among patients seen during the 9-month study period. Ability to maintain the CRS was measured by days of reminder printing. Field notes were used to examine each practice's cohesion and technology capabilities.

Results: All but one practice increased their CRC screening rates, ranging from 3.3% to 16.8% improvement. t tests adjusted for within practice correlation showed improvement in screening rates across all 12 practices, from 41.7% to 50.9%, P = 0.002. Technology capabilities impacted printing days (74% for high technology vs. 45% for low technology practices, P = 0.01), and cohesion demonstrated an impact trend for screening (15.3% rate change for high cohesion vs. 7.9% for low cohesion practices).

Conclusions: Implementing a generalizable CRS in diverse primary care practices yielded significant improvements in CRC screening rates. Technology capabilities are important in maintaining the system, but practice cohesion may have a greater influence on screening rates. This work has important implications for practices implementing reminder systems.

© 2008 Lippincott Williams & Wilkins, Inc.


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