Case studies

The following are summaries of initiatives to increase CRC screening rates. All the following studies utilized CMAs (AAMA) and other medical assistants in advanced roles, and all of them resulted in increases in CRC screening rates.

“Increasing Colorectal Cancer Screening Rates: Steps to Success”

The Maine Cancer Screening Initiative1 was conducted from December 2013 to November 2015 with the participation of six federally qualified health centers (FQHCs) and support from the Maine Primary Care Association (MPCA), Maine Cancer Foundation (MCF), and American Cancer Society (ACS). A key guiding principle of the study was to utilize health professionals to the top of their respective licensing, certification, and education.1

An important aspect of this initiative was the employing and training of “outreach medical assistants” to contact patients who were due for a CRC screening. In addition to following a script when calling patients or their representatives, the medical assistants received advanced training in the fecal immunochemical test (FIT)—a screening tool for detecting CRC.1

“Improving Colon Cancer Screening Rates in Primary Care: A Pilot Study Emphasizing the Role of the Medical Assistant”

This pilot study2 was undertaken at the University of Utah Community Clinics by the Utah Health Research Network and focused on patients 50 years of age and older who had not completed necessary CRC screening. Medical assistants were taught about CRC screening guidelines and were authorized by the overseeing physician to recommend testing to patients. If patients agreed to move forward with the CRC screening, medical assistants were empowered to enter preliminary orders into the electronic health record (EHR) for a screening appointment. The delegating physician would review the orders and determine whether they should be issued.

Note the following synopsis of the results of this study: 

The baseline colonoscopy referral rate was 6.0%. Provider education and electronic reminders had minimal immediate impact on screening rates. Addition of the expanded [medical assistant] role was associated with a sustained increase in colonoscopy referral order rate to 13.4%, a relative improvement of 123%.2

“Colorectal Cancer Screening and the Patient-Centered Medical Home”

This July 2016 webinar3 was conducted under the aegis of the National Colorectal Cancer Roundtable (NCCRT) and the American Cancer Society. One of its purposes was to “consider ways to align colorectal cancer (CRC) screening with the patient-centered medical home (PCMH).”3 Experience had shown that electronic reminders to patients did not increase CRC screenings to any appreciable extent. However, “medical assistant/nurse in-reach and outreach screening processes” proved to be more effective in increasing the rate of CRC screening.3

“Smart Options for Screening (SOS)”

Smart Options for Screening (SOS)4 was one of the research-tested intervention programs of the National Cancer Institute (NCI). The emphasis of the SOS approach was employing EHRs to their full capacity to increase the rate of CRC screening. The role of medical assistants in the SOS system was crucial.

Medical assistants successfully completed two days of focused SOS training. This learning was reinforced by periodic refresher courses and monthly conference calls. The training equipped the medical assistants to explain the screening options to patients in understandable terms, help patients overcome their fears, and encourage patients to move forward with their CRC screening.4

“Colorectal Cancer Screening: Interventions That Work”

This June 2015 webinar5 was presented by Durado Brooks, MD, MPH, then director of cancer control interventions for the American Cancer Society (now vice president), and was sponsored by the Arizona Alliance for Community Health Centers (AACHC) and Arizona Cancer Prevention and Control. Dr. Brooks stated that standing orders permitting medical assistants and nursing staff to explain CRC screening options to patients, provide patients with FIT and fecal occult blood test (FOBT) kits and instructions, and—as authorized by their overseeing licensed providers—refer patients for colonoscopies “have been demonstrated to increase CRC screening rates.”5

“Using Practice Facilitation to Increase Rates of Colorectal Cancer Screening in Community Health Centers, North Carolina, 2012–2013: Feasibility, Facilitators, and Barriers”

This study6 was conducted in three federally qualified health centers (FQHCs) and attempted to measure the importance of involving all staff—including medical assistants—in the effort to increase the CRC screening rate of patients. The results of this initiative were encouraging:

The percentage of eligible patients with a documented colorectal cancer screening recommendation increased from 15% to 29%. The percentage of patients up to date with [CRC] screening rose from 23% to 34%.6

Conclusion

In short, the utilization of knowledgeable and competent medical assistants, especially CMAs (AAMA), across health care settings significantly increases CRC screening rates, which will, in turn, make strides in preventing avoidable deaths through early detection and treatment.