Aurora Health Care, Milwaukee, WI
Disparities in Colorectal Cancer Screening

Background: Colorectal cancer (CRC) is a national healthcare priority, as well as an Aurora Health Care (AHC) quality metric and a care gap per AHC’s CHNA. Our residency clinics face challenges associated with urban underserved populations, and the clinics are currently under the goal for the CRC screening quality metric. Studies have identified disparities in CRC screening, with screening less prevalent among patients who are uninsured and/or of lower socioeconomic status, African American/black, Asian, or non-English speaking Hispanic. Information on age-related disparities in CRC screening rates among eligible patients is limited.

Methods: A team of residents/faculty framed our approach using the Institute for Healthcare Improvement Model for Improvement. Providers at 2 family medicine clinics identified barriers to CRC screening using a fishbone approach to engage them in the improvement process. A retrospective analysis of all patients eligible for CRC screening at 2 targeted clinics, a control clinic (a residency clinic in the same ZIP code), and our care region during a 12-month period (December-November 2015) was completed in collaboration with AHC quality improvement specialists. The percentage of patients achieving the CRC screening metric was reported by REAL-G (race, ethnicity, age, language, gender) and insurance status. Categories with an n < 25 were omitted. The criterion for disparity within a category was identified as >10%. The analysis was repeated in January 2017 for the intervention period (January-December 2016).

Results: The analysis showed that screening rates at all facilities and in the care region overall were lowest among patients in the 50- to 54-year-old age bracket. Identifying a specific disparity group provided a focus for improvement. After the intervention, screening rates in this age group increased in the 2 targeted clinics and overall. Increased CRC screening rates appear to be influenced by improved CRC ordering workflows, clinic provider/staff education, and staff champions who are CRC advocates and who implement changes. The project created dialog about CRC screening rates in several AHC-wide groups, which may have encouraged change in our care region.

Conclusion: Analyzing local population data via REAL-G categories provides new insights into how to reduce health disparity gaps and further our progress toward achieving best in our state care for all patients.