Nease DE et al. 2008 "Impact of a generalizable reminder system on colorectal cancer screening in diverse primary care practices - a report from the prompting and reminding at encounters for prevention project."

Nease DE, Ruffin MT, Klinkman MS, et al. Impact of a generalizable reminder system on colorectal cancer screening in diverse primary care practices - a report from the prompting and reminding at encounters for prevention project. Med Care 2008;46(9):S68-S73.
"Background: Computerized reminder systems (CRS) show promise for increasing preventive services such as colorectal cancer (CRC) screening. However, prior research has not evaluated a generalizable CRS across diverse, community primary care practices. We evaluated whether a generalizable CRS, ClinfoTracker, could improve screening rates for CRC in diverse primary care practices.
Methods: The study was a prospective trial to evaluate ClinfoTracker using historical control data in 12 Great Lakes Research In Practice Network community-based, primary care practices distributed from Southeast to Upper Peninsula Michigan. Our outcome measures were pre- and post-study practice-level CRC screening rates among patients seen during the 9-month study period. Ability to maintain the CRS was measured by days of reminder printing. Field notes were used to examine each practice's cohesion and technology capabilities.
Results: All but one practice increased their CRC screening rates, ranging from 3.3% to 16.8% improvement. T-tests adjusted for within practice correlation showed improvement in screening rates across all 12 practices, from 41.7% to 50.9%, P = 0.002. Technology capabilities impacted printing days (74% for high technology vs. 45% for low technology practices, P = 0.01), and cohesion demonstrated an impact trend for screening (15.3% rate change for high cohesion vs. 7.9% for low cohesion practices).
Conclusions: Implementing a generalizable CRS in diverse primary care practices yielded significant improvements in CRC screening rates. Technology capabilities are important in maintaining the system, but practice cohesion may have a greater influence on screening rates. This work has important implications for practices implementing reminder systems."
To "evaluate whether a generalizable [computerized reminder system] could improve screening rates for [colorectal cancer] in diverse primary care practices."
Tools Used
Type Clinic
Primary care
Small, medium and large
Other Information
The clinics varied in size.
Type of Health IT
Computerized clinical reminders (CRs) and alerts
Type of Health IT Functions
The reminder system "is capable of tracking complete coded problem lists for patients and delivering a wide variety of reminders for preventive and disease management services. However, for [this project] the system was limited to providing [colorectal cancer (CRC)] screening reminders. [The program's] CRC screening reminders are driven according to U.S. Preventive Services Task Force guidelines by age and history of prior screening services, be these fecal occult blood test, flexible sigmoidoscopy, colonoscopy, or air contrast barium enema...In all but 2 practices, [the program] was integrated with electronic appointment systems so that reminders were automatically printed in advance of patient appointments. In the 2 practices without electronic scheduling, patient charts were preceded with reminder forms." In the three study arms, reminders were delivered to clinicians only, patients only or both patients and clinicians.
Context or other IT in place
In all but two of the practices involved in the study, the computerized reminder system used in the study was integrated with a pre-existing electronic appointment system. Only two of the practices had electronic health records (EHRs) at the time of the
Workflow-Related Findings
"Practices printed reminders on average 59% of study days (range, 38-99%)"
"Our findings of trends toward greater increases in CRC screening in practices where we observed higher organizational cohesion echoes other literature that highlights the importance of teams and change management in primary care practices. Simply printing reminders does not ensure that they are available, accepted, and used by a practice."
"We were ... highly dependent on the practices' staff to reliably ensure operation of [the reminder system], including entry of data into the system showing screening completion."
Study Design
Pre-postintervention (no control group)
Study Participants
Twelve community practices in the Great Lakes Research into Practice Network, located in Michigan, participated. The settings in the study were primarily rural. The authors "sought to select diverse practices in size, organizational structure, and location."