Provider Assessment and Feedback

Introduction

Evidence-based interventions are strategies that are proven to work. The Community Preventive Services Task Force recommends several interventions to increase screening for breast, cervical, and colorectal cancers. They include actions designed to reach patients and actions designed to reach health care providers.

Evidence suggests that combining two or more strategies increases community demand for and access to cancer screening and lowers costs. Strategies should be added to your clinic's daily work process in ways that ensure they will last over time and work well for different cancer programs.

The Community Preventive Services Task Force recommends provider assessment and feedback for breast, cervical, and colorectal cancer screening.

Overview

Research shows that giving feedback to health care providers can increase screenings by 13% for many cancers.

Take a close look at the practices your providers are using to refer patients for screening. Give them positive feedback and ideas about how to talk with their patients about the need for cancer screening. Make sure providers understand the importance of ordering tests for their patients.

How to assess your providers and use the results

For detailed information, see the Provider Assessment and Feedback Planning Guide.

• Decide how to assess your health system's screening practices. Look at the practices of individual providers or groups of providers. Compare their performance to national standards or overall clinic screening rates.
• Collect data by reviewing electronic health records or medical charts.
• Present data in an easy-to-understand graphic or report. Summarize results for the clinic as a whole and for individual providers.
• Use your findings to improve your clinic's practices. Develop a plan to raise your screening rate.

How to make the process work

Some providers may be sensitive to your efforts to evaluate how they recommend and refer patients for screening. Here are some ways to lay the groundwork for success:

• Get buy-in ahead of time: Bring providers and other staff together to discuss your health system's cancer screening policies. Let them have a say in how assessments and feedback will be done. Emphasize the positive results of getting more patients screened.
• Motivate providers: Feedback collected during the assessment should be presented in a way that encourages providers to improve their rates.
• Offer choices: Ask providers and staff if they want one-on-one or group feedback. Don't use names with results except when giving a provider their specific results. Results should be compiled for the group or the overall clinic without names.
• Make time: Give providers time to learn and implement any new processes.
• Provide resources: Find out from your providers what resources or training they need to improve their screening rates. Options include provider reminders, screening guideline refreshers, updates on new testing procedures, pocket guides, and key messages for patients.

You'll also need to:

• Identify a member of your staff to communicate with providers and other staff, take ownership of the process, and encourage staff buy-in.
• Think about what financial investments may be needed to upgrade your electronic health record system or pay for training.
• Conduct a pilot assessment to see how the process works.
• Decide how often to do the assessment.
• Track new activities over time and make changes as needed.
• Write down improvements.

Find a CDC-funded breast and cervical cancer screening or colorectal cancer control program in your area. These programs can partner with you and provide support and technical assistance.

Success story

Health center in Rhode Island finds three ways to improve colorectal cancer screening use

Providence Community Health Centers serve the largest and most diverse population of all the Rhode Island Colorectal Cancer Program's partner health systems. Just 8% of their patients were up to date with colorectal cancer screening in 2014.

The Rhode Island Colorectal Cancer Program and Providence Community Health Centers worked together to raise screening use in three ways. First, they set yearly goals for every doctor and sent them reports every month to let them know what percentage of their patients had been screened. Second, they sent text messages to patients reminding them to get screened for colorectal cancer. Finally, they paid medical assistants to enter the results of 3,500 colorectal cancer screening tests into patients' electronic health charts. Later, the laboratory that processed the stool tests entered the test results directly into the health center's electronic health records.

As a result, Providence Community Health Centers went from being the lowest performing partner health system in Rhode Island to the fifth highest performing one. In 4 years, they increased colorectal cancer screening use to 60%, and 4,664 more underserved patients were screened.