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Implementation of a Low-Cost Quality Improvement Intervention Increases Adherence to Cancer Screening Guidelines and Reduces Healthcare Costs at a University Medical Center

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Abstract

Adherence to US Preventative Services Task Force (USPSTF) cancer screening guidelines remains considerably lower than the recommendation of the Healthy People 2020 initiative. Patient populations recommended for screening are not screened at an appropriate rate, and populations not recommended for screening are inappropriately screened. Closer adherence to guidelines should improve outcomes and reduce costs, estimated to reach $158 billion/year by 2020. We evaluated whether a use of low-cost educational health maintenance (HM) card by medical residents at a university hospital could impact education and adherence to updated cancer screening guidelines. We also analyzed savings to the healthcare system. Adherence to cervical, breast, and colorectal cancer screening guidelines, defined as percentage that was screened (or not screened) in accordance with the USPSTF guidelines, in clinic visits from December 2012 (n = 336) was compared to those from December 2013 (n = 306) after a quality improvement intervention. Post-intervention, adherence to screening guidelines increased by 40.8% (p < 0.01) for cervical, 33.2% (p < 0.01) for breast, and 20.5% (p < 0.01) for colorectal cancer in average-risk patients. Inappropriate screening was reduced by 26.8% (p < 0.01) for cervical and 32.8% (p < 0.01) for breast cancer. A non-significant 1.1% decrease (p = 0.829) was observed for colorectal cancer. The annual potential savings from avoiding inappropriate screenings were $998,316 (95% CI; $644,484–$1,352,148). We showed a significant absolute increase in USPSTF knowledge of 28.3% irrespective of the house staff level that remained high at 2 years from the educational intervention. The low-cost HM card increased appropriate knowledgeable cancer screening adherence while reducing unnecessary testing and producing substantial savings to the healthcare system.

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Acknowledgements

The authors thank Dr. Parham Eshtehardi and Dr. Pavlos Msaouel for their prior research and guidance at Jacobi Medical Center Internal Medicine Residency.

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Authors and Affiliations

  1. Fellow in Hematology and Medical Oncology, University of Arizona Cancer Center, 1515 N Campbell Av, Room 1969, Tucson, AZ, 85724, USA

    Alejandro Recio-Boiles

  2. Jacobi Medical Center, Department of Medicine, Albert Einstein College of Medicine, New York City, NY, USA

    Alejandro Recio-Boiles, Jose N. Galeas, Vineeth Sukrithan & Andrew H. Gutwein

  3. Westchester Medical Center-Department of Medicine, New York Medical College, Valhalla, NY, USA

    Michael Karass

  4. University of Arizona Cancer Center, Department of Medicine, The University of Arizona, Tucson, AZ, USA

    Hani M. Babiker

Authors
  1. Alejandro Recio-Boiles
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  2. Michael Karass
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  3. Jose N. Galeas
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  4. Vineeth Sukrithan
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  5. Andrew H. Gutwein
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  6. Hani M. Babiker
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Contributions

All authors contributed to the writing and revision of the manuscript; the study was designed and led by Dr. Recio-Boiles.

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Correspondence to Alejandro Recio-Boiles.

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IRB 1804508070 and N/A

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Recio-Boiles, A., Karass, M., Galeas, J.N. et al. Implementation of a Low-Cost Quality Improvement Intervention Increases Adherence to Cancer Screening Guidelines and Reduces Healthcare Costs at a University Medical Center. J Canc Educ 35, 930–936 (2020). https://doi.org/10.1007/s13187-019-01544-z

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