Adapting the PPRNet TRIP QI Model to Increase Colorectal Cancer Screening in Primary Care


Background: Established CRCS guidelines for providers and the public exist, but due to several versions of CRCS guidelines and the variety of test options, confusion often arises among patients and providers, adversely affecting CRCS rates. Improving providers’ opportunities to recommend CRCS through provider-directed office-system interventions is critical to increase CRCS rates. Objective: The purpose of this study was to demonstrate the feasibility of adapting provider-directed office-system interventions developed by the Practice Partner Research Network (PPRNet) Translation of Research into Practice (TRIP) Quality Improvement (QI) Model for implementation in an independent, rural West Virginia primary care practice, and to obtain estimates of variability for relevant outcome measures of the interventions to increase CRCS recommendation and rates. Methods: Retrospective and prospective patient data from medical records and electronic medical records were extracted to compare pre-with post-intervention CRCS rates and analyze any significant demographic data. Also, office staff participated in a focus group interview. Results: The pre-intervention CRCS status/completion rate was 4.3% and increased to 36.2%. CRCS recommendation rate rose from 4.3% to 42.1%. Patients in the post group were almost 7 times more likely to get CRCS recommendation compared to patients in the pre group, adjusting for demographic information. Similar to findings for CRCS recommendations, patients in the post group were more than 12 times more likely to have CRCS completion compared to their counterparts in the pre-group (OR 12.61, p < 0.000, CI: 8.30, 19.15). Conclusion: This study demonstrated the feasibility as well as statistically significant preliminary indications that CRCS rates will increase after implementation of this model.

Share and Cite:

K. Atassi, L. Nemeth, B. Edlund, M. Mueller and I. Tessaro, "Adapting the PPRNet TRIP QI Model to Increase Colorectal Cancer Screening in Primary Care," Journal of Cancer Therapy, Vol. 3 No. 6A, 2012, pp. 866-873. doi: 10.4236/jct.2012.326111.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] American Cancer Society, “Cancer Facts and Figures 2012,” 2012.
[2] US Cancer Statistics Working Group, “Unites States Cancer Statistics: 1999-2007 Incidence and Mortality Web-based Report,” US Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute, Atlanta, 2010.
[3] B. Behringer and G. H. Friedall, “Appalachia: Where Place Matters in Health,” Preventing Chronic Disease, Vol. 3, No. 4, 2006, p. 113.
[4] C. A. Coyne, C. Demian-Popescu and D. Friend, “Social and Cultural Factors Influencing Health in Southern West Virginia: A Qualitative Study,” Preventing Chronic Disease, Vol. 3, No. 4, 2006, pp. A124-A124.
[5] Kaiser Family Foundation, “West Virginia: People in poverty,” State Health Facts, 2009.
[6] E. J. Lengerich, S. W. Wyatt, A. Rubio, J. E. Beaulieu, C. A. Coyne and L. Fleisher, A. J. Ward and P. K. Brown, “The Appalachian Cancer Network: Cancer Control Re- search Among a Rural, Medically Underserved Population,” The Journal of Rural Health, Vol. 20, No. 2, 2004, pp. 181-187. doi: 10.1111/j.1748-0361.2004.tb00026.x
[7] N. L. Lyttle, K. Stadelman, “Assessing Awareness and Knowledge of Breast and Cervical Cancer among Appalachian Women,” Preventing Chronic Disease, Vol. 3, No. 4, 2006.
[8] J. S. Haas, G. Fitzmaurice, P. Brawarsky, S. Y. Liang, R. A. Hiatt, C. N. Klabunde, M. L. Brown and K. A. Phillips, “Association of Regional Variation in Primary Care Physicians’ Colorectal Cancer Screening Recommendations with Individual Use of Colorectal Cancer Screening,” Preventing Chronic Disease, Vol. 4, No. 4, 2007, pp. 1-11.;jsessionid=kYFKFV5lt929Y5NJXK3g.6
[9] C. N. Klabunde, P. S. Frame, A. Meadow, E. Jones, M. Nadel and S. W. Vernon, “A National Survey of Primary care Physicians’ Colorectal Cancer Recommendations and Practices,” Preventative Medicine, Vol. 36, No. 3, 2003, pp. 352-362. doi: 10.1016/S0091-7435(02)00066-X
[10] S. W. Vernon, H. Meissner, C. Klabunde, B. K. Rimer, D. J. Ahnen, R. Bastani, M. T. Mandelson, M. R. Nadel, S. Sheinfeld-Gorin and J. Zapka, “Measures for Ascertaining Use of Colorectal Cancer Screening Measures in Behavioral, Health Services, and Epidemiological Research,” Cancer Epidemiology, Biomarkers, & Prevention, Vol. 13, No. 6, 2004, pp. 898-905.
[11] E. K. Wei, C. T. Ryan, A. J. Dietrich and G. A. Colditz, “Improving Colorectal Cancer Screening by Targeting Office Systems in Primary Care Practices,” Archives of Internal Medicine, Vol. 165, No. 6, 2005, pp. 661-666.
[12] D. C. Fyffe, S. V. Hudson, J. K. Fagan, D. R. Brown, “Knowledge and Barriers Related to Prostate and Colorecal Cancer Prevention in Underserved Black Men,” Journal of the National Medical Association, Vol. 100, No. 10, 2008, pp. 1161-1167.
[13] C. N. Klabunde, S. W. Vernon, M. R. Nadel, N. Breen, L.C. Seeff and M. L. Brown, “Barriers to Coloretal Cancer Screening: A Comparison of Reports from Primary Care Physicians and Average-Risk Adults,” Medical Care, Vol. 43, No. 9, 2005, pp. 939-944. doi:10.1097/
[14] C. E. Guerra, J. S. Schwartz, K. Armstrong, J. S. Brown, C. Hughes Halbert, J. A. Shea, “Barriers of and Facilitators to Physician Recommendation of Colorectal Cancer Screening,” Journal of General Internal Medicine, Vol. 22, No. 12, 2007, pp. 1681-1688. doi: 10.1007/s11606-007-0396-9
[15] J. Zapka, “Inovative Provider- and Health System-Directed Approached to Improving Colorectal Cancer Screening Delivery,” Medical Care, Vol. 9, No. 1, 2008, pp. S62-S67. doi: 10.1097/MLR.0b013e31817fdf57
[16] U.S. Preventive Services Task Force, “Screening for Colorectal Cancer: US Preventive Services Task Force Recommendations Statement,” Annals of Internal Medicine, Vol. 149, No. 9, 2008, pp. 627-637.
[17] H. A. Beydoun, M. A. Beydoun, “Predictors of Colorectal Cancer Screening Behaviors among Average-Risk Adults in the United States,” Cancer Causes and Control, Vol. 19 No. 4, 2008, pp. 339-359. doi: 10.1007/s10552-007-9100-y
[18] I. Guessous, C. Dash, P. Lapin, M. Doroshenk, R. A. Smith, C. N. Klabunde and National Colorectal Cancer Roundtable Screening among the 65 Plus Task Group, “Colorectal Cancer Screening Barriers and Facilitators in Older Persons,” Preventative Medicine, Vol. 50, No. 1-2, 2010, pp. 3-10.;jsessionid=IfuFnFy4GFuJOwmNqoGS.8
[19] C. N. Klabunde, D. Lanier, E. S. Breslau, J. G. Zapka, et al., “Improving Colorectal Cancer Screening in Primary Care Practice: Innovative Strategies and Future Directions,” Society of General Internal Medicine, Vol. 22, No. 8, 2007, pp. 1195-1205. doi: 10.1007/s11606-007-0231-3
[20] M. Sarfaty, R. Wender, “How to Increase Colorectal Cancer Screening Rates in Practice,” CA: A Cancer Journal for Clinicians, Vol. 57, No. 6, 2007, pp. 354-366. doi: 10.3322/CA.57.6.354
[21] L. C. Seef, M. R. Nadel, C. N. Klabunde, et al., “Patterns and Predictors of Colorectal Cancer Test Use in the US Adult Population,” Cancer, Vol. 100, No. 10, 2004, pp. 2093-2103. doi: 10.1002/cncr.20276
[22] S. Subramanian, M. Klosterman, M. M. Amonkar and T. L. Hunt, “Adherence with Colorectal Cancer Screening Guidelines: A Review,” Preventive Medicine, Vol. 38, No. 5, 2004, pp. 536-550. doi: 10.1016/j.ypmed.2003.12.011
[23] S. A. Sabatino, N. Harbarta, R. C. Baron, R. J. Coates, et al., “Interventions to Increase Recommendation and De- livery of Screening for Breast, Cervical, and Colorectal Cancers by Health Care Providers: Systematic Reviews of Provider Assessment and Feedback of Provider Incentives,” American Journal of Preventive Medicine, Vol. 35, No. 1, 2008, pp. S67-S74. doi: 10.1016/j.amepre.2008.04.008
[24] J. G. Zapka, S. C. Lemon, “Interventions for Patients, Providers, and Health Care Organizations,” Cancer, Vol. 101, No. S5, 2004, pp. 1165-1187. doi: 10.1002/cncr.20504
[25] D. S. Lane, C. R. Messina, M. F. Cavanagh and J. J. Chen, “A Provider Intervention to Improve Colorectal Cancer Screening in County Health Centers,” Medical Care, Vol. 46, No. 9, 2008, pp. S109 - S116. doi: 10.1097/MLR.0b013e31817d3fcf
[26] S. Ornstein, L. S. Nemeth, R. G. Jenkins and P. J. Nietert, “Colorectal Cancer Screening in Primary Care: Translating Research into Practice,” Medical Care, Vol. 48, No. 10, 2010, pp. 900-906. doi: 10.1097/MLR.0b013e3181ec5591
[27] S. Ornstein, P. J. Nietert, R. G. Jenkins, A. M. Wessell, L. S. Nemeth and H. L. Rose, “Improving the Translation of Research into Primary Care Practice: Results of a National Quality Improvement Demonstration Project,” Joint Commission Journal on Quality and Patient Safety, Vol. 34, No. 7, 2008, pp. 379-390.
[28] C. Feifer and S. M. Ornstein, “Strategies for Increasing Adherence to Clinical Guidelines and Improving Patient Outcomes in Small Primary Care Practices,” Joint Commission Journal on Quality and Safety, Vol. 30, No. 8, 2004, pp. 432-441.
[29] L. S. Nemeth, C. Feifer, G. W. Stuart and S. M. Ornstein, “Implementing Change in Primary Care Practices Using Electronic Medical Records: A Conceptual Framework,” Implementation Science, Vol. 3, 2008, p. 3. doi:10.1186/1748-5908-3-3
[30] L. S. Nemeth, P. J. Nietert and S. Ornstein, “High Performace in Screening for Colorectal Cancer: A Practice Partner Research Network (PPRNet) Case Study,” Journal of the American Board of Family Medicine, Vol. 22, No. 2, 2009, pp. 141-146. doi: 10.3122/jabfm.2009.02.080108
[31] C. N. Klabunde, D. Lanier, H. I. Meissner, E. S. Breslau and E. R. Brown, “Improving Colorectal Cancer Screening through Research in Primary Care Settings,” Medical Care, Vol. 46, No. 9, 2008, pp. S1-S4. doi: 10.1097/MLR.”0b013e3181805e2a
[32] L. S. Nemeth, A. M. Wessell, R. G. Jenkins, P. J. Nietert, H. A. Liszka and S. M. Ornstein, “Strategies to Accelerate Translation of Research into Primary Care Within Practices Using Electronic Medical Records,” Journal of Nursing Care Quality, Vol. 22, No. 4, 2007, pp. 343-349. doi: 10.1097/01.NCQ.0000290416.27393.d8
[33] D. Steinwachs, J. D. Allen, W. E. Barlow, et al., “National Institutes of Health State-of-the-Science Conference Statement: Enhancing Use and Quality of Colorectal Cancer Screening,” Annals of Internal Medicine, Vol. 152, No. 10, 2010, pp. 663-667.
[34] P. M. Green, B. A. Kelly, “Colorectal Cancer Knowledge, Perceptions, and Behaviors in African Americans,” Cancer Nursing, Vol. 27, No. 3, 2004, pp. 206-215. doi:10.1097/00002820-200405000-00004
[35] A. S. O'Malley, E. Beaton, K. R. Yabroff, et al., “Patient and Provider Barriers to Colorectal Cancer Screening in the Primary Care Safety-Net,” Preventative Medicine, Vol. 39, No. 1, 2004, pp. 56-63. doi: 10.1016/j.ypmed.2004.02.022
[36] J. M. Daly, B. T. Levy, M. L. Merchant and J. Wilbur, “Mailed Fecal-Immunochemical Test for Colon Cancer Screening,” Journal of Community Health, Vol. 35, No. 3, 2010, pp. 235-239. doi: 10.1007/s10900-010-9227-8

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.