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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

doi: 10.1097/MLR.0b013e31817c60d7

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.

From the *Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; †School of Public Health, University of Michigan, Michigan; and ‡School of Social Work, University of Michigan, Michigan.

Supported by National Cancer Institute/Agency for Healthcare Research and Quality “Colorectal Cancer Screening in Primary Care Practice” program grant R21 CA104484.

Dr. Nease and Dr. Klinkman serve on the Medical Advisory Board of Cielo and receive royalties from the University of Michigan.

Reprints: Donald E. Nease, Jr., MD, Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48104-1213. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.