Common Keyword: EHR/EMR

Electronic health record/electronic medical record

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Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Primary Care Practices

Colorectal cancer screening saves lives, yet more than 1 in 3 adults ages 45 and older is not getting screened as recommended.

Through a step-by-step format, this newly updated manual provides evidence-based, expert-endorsed strategies to improve colorectal cancer screening rates in primary care practices. The 2022 edition includes:

  • An expanded scope to include all primary care settings
  • Current screening guidelines and new screening modalities
  • Expert-endorsed strategies
  • Samples, templates, and tools
  • Updated literature references
  • NEW! Added exemplary case studies

Learn More

Background and Goals

The first edition, published in 2014, was one of the NCCRT’s most popular resources and has been instrumental in helping primary care practices throughout the United States achieve improvements in their colorectal cancer screening rates.  

The goal of this manual is to offer evidence-based, expert-endorsed recommendations for planning and implementing strategies in primary care practices to improve colorectal cancer screening rates. This manual provides a succinct step-by-step guide for primary care teams to improve colorectal cancer screening and outcomes in practice. These simple steps will assist teams to effectively:

  • Agree on and implement an office screening strategy
  • Provide education on appropriate and high-quality screening
  • Help patients to complete timely, recommended screening
  • Track follow-up of screening and results
  • Build networks among primary care, specialty care, and health systems
  • Provide examples of workflows from successful programs

View the NCCRT’s July 25, 2022 Steps Guide update webinar recording and slide set for an introduction to the new edition and testimonials from two primary care clinician champions on how the manual can be used to transform colorectal cancer screening delivery.  

Acknowledgement

The NCCRT would like to thank the numerous people who generously offered their time and expertise to the development of this updated second edition.

NCCRT is especially grateful to the advisory committee, who generously offered their time and expertise to develop this guidebook’s research and content, to HealthEfficient for serving as the lead author on this second edition, and to the Centers for Disease Control and Prevention for their support.

See the Acknowledgements section on page two of the Steps Guide for a comprehensive list of the many contributors.

This publication was supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $825,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.


Spread The Word

Sample Facebook & LinkedIn Posts

Colorectal cancer screening is one of the best ways to reduce the risk of colorectal cancer. Utilize the strategies in our Steps Guide to help increase screening rates in patients, and reference the newly added Case Studies to see their impact. https://nccrt.org/StepsGuide #80inEveryCommunity

Primary care clinicians’ use of our Steps Guide can help increase colorectal cancer screening rates in patients. We’re excited to include newly added case studies give insight into the effectiveness of strategies, all to meet the goal of #80inEveryCommunity. Read more: https://nccrt.org/StepsGuide  

Timely colorectal cancer screening is more important than ever now that major guidelines recommend screening start at age 45. The National Colorectal Cancer Roundtable’s newly updated Steps Guide provides a succinct step-by-step guide for primary care teams to improve colorectal cancer screening and outcomes in practice. https://nccrt.org/StepsGuide

Colorectal cancer screening saves lives. Learn how you can increase screening rates in primary care with the National Colorectal Cancer Roundtable’s newly updated Steps Guide: https://nccrt.org/StepsGuide

The lifetime risk of developing colorectal cancer is about 1 in 24 for men and 1 in 25 for women, yet nearly 1 in 3 adults ages 50 and older is not getting screened as recommended. The National Colorectal Cancer Roundtable’s newly updated Steps Guide is your one-stop-shop for strategies to increase colorectal cancer screening in your practice. Get started now at https://nccrt.org/StepsGuide

Only 72% of adults aged 50 and older are up to date with potentially life-saving colorectal cancer screening. Download the National Colorectal Cancer Roundtable’s newly updated Steps Guide to find evidence-based, expert-endorsed strategies to improve colorectal cancer screening rates. https://nccrt.org/StepsGuide

Sample Tweets

Colorectal cancer screening is one of the best ways to reduce the risk of colorectal cancer. Utilize the strategies in our Steps Guide to help increase screening rates in patients, and reference the newly added Case Studies to see their impact. https://nccrt.org/StepsGuide #80inEveryCommunity

Primary care clinicians’ use of our Steps Guide can help increase colorectal cancer screening rates in patients. We’re excited to include newly added case studies give insight into the effectiveness of strategies, all to meet the goal of #80inEveryCommunity. Read more: https://nccrt.org/StepsGuide  

The lifetime risk of developing colorectal cancer is about 1 in 24 for men and 1 in 25 for women. The new @NCCRTnews Steps Guide is your one-stop-shop for strategies to increase #CRC screening. https://nccrt.org/StepsGuide #80inEveryCommunity #GetScreened

Colorectal cancer screening saves lives. Learn how you can increase screening rates in your practice with the new @NCCRTnews Steps Guide: https://nccrt.org/StepsGuide #80inEveryCommunity #GetScreened

Major guidelines recommend people at average risk start colorectal cancer screening at age 45. Download the new @NCCRTnews Steps Guide for a succinct step-by-step guide to increase #CRC screening in primary care. https://nccrt.org/StepsGuide #80inEveryCommunity #GetScreened

Only 72% of adults aged 50+ are up to date with potentially life-saving colorectal cancer screening. Download the @NCCRTnews Steps Guide for evidence-based, expert-endorsed recommendations to improve #CRC screening rates. https://nccrt.org/StepsGuide #80inEveryCommunity #GetScreened

Template Newsletter Blurbs

Brief version:

The National Colorectal Cancer Roundtable’s newly released Steps Guide (www.nccrt.org/StepsGuide) provides evidence-based, expert-endorsed strategies to increase colorectal cancer screening rates in primary care. This 2023 edition offers a much-anticipated update to the signature NCCRT resource that has been instrumental in helping primary care practices throughout the United States achieve improvements in delivering potentially life-saving colorectal cancer screening in the communities they serve.

Extended version:

A primary care clinician recommendation is the most powerful influence on a patient’s decision to get screened for cancer. Download the National Colorectal Cancer Roundtable’s 2023 edition of the Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Primary Care Practices (www.nccrt.org/StepsGuide) to find evidence-based, expert-endorsed strategies to improve colorectal cancer screening rates in primary care. 

This 2023 version provides a much-anticipated update to the signature NCCRT resource that has been instrumental in helping primary care practices throughout the United States achieve improvements in delivering potentially life-saving colorectal cancer screening in the communities they serve as well as ten exemplary case studies. Timely colorectal cancer screening is more important than ever now that major guidelines recommend screening for people at average risk start at age 45. 

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Colorectal Cancer Screening and Risk Assessment Workflow and Documentation Guide for Health Center NextGen Users

This Guide provides focused documentation to assist users of NextGen software to improve the process of assessing, documenting, tracking, and following up on colorectal cancer screening. The Guide gives particular attention to assessment of personal and family risk and the tracking and follow-up of screening results that are not addressed in the standard NextGen guidance documents.

The Guide was initially developed by Harbor Health Services in collaboration with the Massachusetts League of Community Health Centers and NACHC, with support from the American Cancer Society. 

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Colorectal Cancer Screening Best Practices: A Handbook for Hospitals and Health Systems

The purpose of the Colorectal Cancer Screening Best Practices: A Handbook for Hospitals and Health Systems is to provide advice on the design and delivery of a variety of effective CRC screening interventions to help all hospitals and health systems strengthen their colorectal cancer screening efforts.  With their expertise in both improving health and in serving as leaders in their communities, hospitals and health systems are uniquely positioned to play a pivotal role in increasing colorectal cancer screening for those they serve.  The handbook is divided into four sections:  Critical Steps, Case Studies, Implementation, and Tools & Resources. It is intended to provide you with needed information drawn from real life examples about how to ultimately improve CRC screening rates within the hospital and health system setting.

A corresponding webinar was held in July 2018 announcing the release of the handbook and included presentations from two health systems featured in the guide. View the Colorectal Cancer Screening Best Practices for Hospitals and Health Systems webinar.

Many thanks to the hospitals and health systems featured in the guide for sharing their time and their tremendous expertise, as well as to handbook’s expert advisory group, which was chaired by Drs. Michael Potter and Dorothy Lane, Co-Chairs of the NCCRT Professional Education and Practice Implementation Task Group.

This handbook is dedicated to the memory of Marie LaFargue.

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Interactive Table of Contents
Sample Screening Algorithms

Risk Assessment And Screening Toolkit To Detect Familial, Hereditary And Early Onset Colorectal Cancer

Limited or inaccurate family history collection and risk assessment is a major barrier to successful cancer screening. Individuals who have a first-degree relative with colorectal cancer (CRC) are at least two times more likely to develop CRC, with the risk increasing with earlier ages of diagnosis and the number of relatives diagnosed with CRC. Therefore, screening and prevention efforts must focus on those with familial or hereditary risk, which requires collecting the necessary family history information for risk assessment. Primary care clinicians play a pivotal role in identifying people at increased CRC risk and facilitating recommended screening.

This new NCCRT toolkit aims to improve the ability of primary care clinicians to systematically collect, document, and act on a family history of CRC and adenomas polyps, while also educating clinicians on the need for more timely diagnostic testing for young adults who present with alarm signs or symptoms of CRC and ensuring that those patients receive a proper diagnostic work up. This toolkit serves as a comprehensive, step-by-step guide to improve operations within practices and suggests many useful resources and tools to aid these changes. 

Companion Quick Start Guide

Accompanying the full toolkit is a short, quick start guide with recommendations on how to ease into the transition process, while still making the critical improvements necessary for successful system-wide implementation. 

Thank you to the outstanding work and guidance provided from the NCCRT Family History and Early Age Onset Colorectal Cancer Task Group and the smaller project advisory group. Also, thank you to the excellent work from our project developers at The Jackson Laboratory. 

 

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best practices handbook for health plans
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“Thank you! This is exactly the type of information health plans need to pass to one another to improve partnership/collaboration, as the consumer will benefit at the end.”

“I really enjoyed that each of the health plans featured in the toolkit highlights a different intervention or opportunity. That gives our partners many approaches to choose from.”

Colorectal Cancer Screening Best Practices Handbook for Health Plans

Health plans have an essential role to play in the effort to screen more Americans for colorectal cancer, particularly given that seven out of 10 people who are unscreened are covered by insurance.

Colorectal Cancer Screening Best Practices Handbook for Health Plans, provides a first-of-its-kind compilation of best practices, case studies, templates and tools, that will kick start or infuse health plans’ efforts to save more lives and prevent more cancers.

To develop the handbook, the NCCRT convened an advisory group of health plan experts and interviewed high-performing health plans to understand what works and what doesn’t when it comes to increasing screening among members. Thank you to the many individuals and organizations who contributed their time and expertise to developing this much requested resource.

In the future, we hope to update this handbook with more case studies from high-performing health plans. If you have a story to share about how your health plan has worked to raise colorectal cancer screening rates, please email nccrt@cancer.org.

NCCRT’s issue brief, The Importance of Waiving Cost-sharing for Follow-up Colonoscopies, provides additional information on the colonoscopy copay issue.

View the March 28, 2017 webinar introducing the Handbook for a guided tour of the best practices, case studies, and templates and tools found within the handbook, and hear from one of the profiled health plans.

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Colorectal Cancer Screening Best Practices Handbook For Health Plans

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Colorectal Cancer Screening Best Practices Handbook for Health Plans – March 28, 2017

This webinar introduced the new NCCRT Colorectal Cancer Screening Best Practices Handbook for Health Plans. The purpose of this handbook is to provide health plans with advice on the design and delivery of effective colorectal cancer screening programs. The webinar provided participants with a guided tour of the best practices, case studies, and templates and tools found within the handbook, including a deeper dive into the exemplary practices for one of the profiled health plans.

Speakers:

  • Tamara O’Shaughnessy, QNA Group
  • Anshul Dixit, MD, MPH, MBA, Wellmark Blue Cross and Blue Shield

“This was one of the best colorectal cancer presentations, and it also provided information we can readily utilize with our current health plans in support of the 80% by 2018 initiative.”

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CDC replication manual
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New Hampshire Colorectal Cancer Screening Program Patient Navigation Model Replication Manual

The New Hampshire Colorectal Cancer Screening Program (NHCRCSP) patient navigation model has been highly effective in increasing the completion and quality of colonoscopy screening and surveillance among statewide underserved groups. Patients in this program, all of whom were navigated, were 11 times more likely to complete colonoscopy than non-navigated patients in a comparison group. Given this success, the Centers for Disease Control and Prevention (CDC) and the NHCRCSP worked together to develop a manual to help others replicate the model. The manual includes step-by-step instructions for implementing a screening navigation program, including a detailed navigation protocol, guidance on data collection, navigator training, and sample templates and tools.

Intended Audiences: Any organization that conducts colorectal cancer screening or administers a colonoscopy program may benefit from implementing this intervention. Organizations could include health systems, endoscopy centers, primary care practices (including Federally Qualified Health Centers), universities, state or local health departments, and grantee programs. This manual also may be useful for health care providers, pharmacy staff, and other community partners to clarify their roles in the intervention and how it benefits their patients.

Congratulations to former NCCRT Steering Committee member Dr. Lynn Butterly and to all the others who helped create this resource.

Evaluation: A rigorous evaluation was conducted, including a comparison of NHCRCSP-navigated patients to a similar group of non-navigated patients. Learn more on page 8 and in Appendix D. Evaluation results were also published in the journal Cancer.

Permissions: Made publicly available online through the Centers for Disease Control and Prevention.

Publication date: October 2016

Post date: September 18, 2017

Contact: Send comments, questions, and suggestions to NHPNManual@cdc.gov or NHCRCSP@hitchcock.org.

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EClinicalWorks Best Practices Guide

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eClinicalWorks Best Practices Guide – May 5, 2016

This webinar provided an in-depth look at our eClinicalWorks Best Practices Workflow and Documentation Guide to support colorectal cancer screening for eClinicalWorks. This webinar is best suited for those who work directly with EHRs and eClinicalWorks in particular. This is not an introductory webinar.

Speakers:

  • Sandy Carfachio, Health Center Network of New York
  • Michelle Tropper, MPH, Health Center Network of New York
  • Carla Henke, MD, Community of Hope
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Waiving Colonoscopy Co-Pays

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Waiving Colonoscopy Co-pays – April 12, 2016

This webinar explained what’s covered with respect to colorectal cancer screening, what’s not covered and how to code for it; provided an update on federal and state efforts to remove cost sharing for colorectal cancer screening; and described a case study in which Gateway Health of Pennsylvania plan removed copays for colonoscopies following positive FIT tests. Learn more about the cost-sharing issue in the brief: The Importance of Waiving Cost-sharing for Follow-up Colonoscopies: Action Steps for Health Plans.

Speakers:

  • Joel Brill, MD, American Gastroenterological Association
  • Caroline Powers, American Cancer Society Cancer Action Network, Inc.
  • Marnie Schilken, MPH, Gateway Health
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NACHC-ACS CRC Project Culmination Summary Final
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EHR Best Practice Workflow and Documentation Guide to Support Colorectal Cancer Screening Improvement with eClinicalWorks

The NCCRT commissioned the Health Center Network of New York (HCNNY) to develop EHR Best Practice Workflow and Documentation Guide to Support Colorectal Cancer Screening Improvement with eClinicalWorks. Please note that this tool is an advanced tool designed to inform those who work directly with electronic health records (EHRs). The overall goal of the project was to identify and document specific best practice workflows that support appropriate CRC screening and follow up and proper utilization of family history data within the eClinicalWorks EHR system (eCW). The guide is also intended to further enable FQHCs to employ existing CRC screening improvement tools to ultimately yield improved patient health outcomes. HCNNY will continue to enhance the guide as further information and/or product capabilities related to CRC screening become known. HCNNY and its participating FQHCs learned a great deal throughout this project and while the challenges of ensuring timely CRC screening for all patients are far from resolved, the detailed recommendations developed provide a roadmap for documentation that will assist health centers in building the necessary foundation for more reliable, actionable information to support their efforts to improve CRC screening rates. We are thankful for the support and collaboration from the National Association of Community Health Centers (NACHC), the American Cancer Society (ACS) and the National Association of Chronic Disease Directors (NACDD) in developing this tool.

Watch the May 5, 2016 webinar introducing this new resource to learn more.