In 2010, the U.S. Department of Health and Human Services implemented a quality improvement initiative known as “Healthy People 2020” designed to improve outcomes across a broad array of illnesses by 2020. Within the category of cancer, the initiative's goals include improving screening rates. As poor socioeconomic status has long been associated with lower screening and higher mortality rates, and given the low socioeconomic status of much of our patient population, our institution has implemented Six Sigma techniques designed to decrease variability in cancer screening measures, reduce healthcare disparities, and improve screening outcomes.
Beginning in the 4th quarter of 2013, our hospital's Ambulatory Care department implemented a bimonthly rapid cycle evaluation of physicians designed to analyze a variety of patient care metrics including breast and colorectal cancer screening rates within each physician's respective patient panel. Data for each quarter was systematically distributed to each physician and a care navigation team was assembled to ensure screening compliance via patient outreach in the form of phone calls and certified mail.
Data from the 1st quarter of 2014 until the 2nd quarter of 2015 were collected from two sites affiliated with our institution's outpatient service. During that timeframe, the rate of colorectal screening—which includes colonoscopy and serial fecal occult blood testing—increased at Site 1 from 79.1% to 84.4% and at Site 2 from 70.8% and 75%. With respect to breast cancer screening, the rate at Site 1 remained virtually unchanged (90.4% and 90.1%) while the rate at Site 2 increased from 80.7% to 86.0%.
As our intervention has demonstrated, cancer screening may be optimized by the use of a low-cost, easily implementable, and easily replicable intervention leveraging Six Sigma instruments. In light of the challenges affecting our institution's predominately African-American and Latino populations—particularly as they relate to access to care and timely cancer diagnoses—our intervention may go a long way toward reducing disparities and improving outcomes in these increasingly disadvantaged populations.
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All authors have declared no conflicts of interest.