Study Suggests Implementing New Evidence-Based Interventions Improves CRC Screening Rates

Investigators suggested that findings across different clinics can help inform future implementation of the Colorectal Cancer Control Program (CRCCP).

According to a study of the Colorectal Cancer Control Program (CRCCP) published in Cancer, implementing new evidence-based interventions (EBIs) or enhancing those that already exist improves colorectal cancer (CRC) screening rates.

In addition, the results demonstrated that clinics with lower screening rates in the prior year experienced greater rate increases and may have benefited more from the use of CRCCP.

Importantly, the successful implementation of EBIs in primary care clinics remains dependent on other activities such as quality improvement initiatives, effective electronic health systems, and efficient referral and patient tracking systems for colonoscopy. However, these results demonstrate that introducing such evidence-based interventions as those identified in the current study can increase CRC screening rates in clinics.

“The results might be useful to other public health programs working with primary care clinics,” wrote the study authors, who were led by Krishna P. Sharma, PhD.

In order to understand the critical differences in the characteristics and implementation efforts of clinics with differential changes in their screening rates, investigators evaluated clinics participating in the CRCCP, consisting of mainly federally qualified health centers or community health centers. The main outcome of the study used the absolute screening rate change between the first and second program years to define the clinic status, including those falling into the highest quartile (Q4) or the lowest quartile (Q1).

There were a total of 156 clinics evaluated, including 78 clinics each in the Q4 and Q1 groups. The average screening rates in program year 1 were 39.6% for those in Q4 and 40.8% for those in Q1; however, these rates changed to 53.7% and 32.0%, respectively, in program year 2.

Overall, clinics classified as Q4 were more likely than those deemed to be Q1 to have a CRC champion, employ 4 EBIs versus fewer EBIs overall, implement at least 1 new EBI during the second year, and increase the number of implemented EBIs between years.

If a clinic implemented an additional EBI, the adjusted odds of Q4 status were 5.3 times greater (95% CI, 1.9-14.9). Moreover, if a clinic implemented 2 to 4 additional EBIs, the adjusted odds of Q4 status increased to 7.1 (95% CI, 2.2-23.1).

“By restricting our analyses to the clinics with the highest and lowest [screening rate changes; SRCs], we excluded half of the CRCCP clinic data (ie, data from those clinics with SRCs ranked in the second and third quartiles),” the authors noted. “However, the sensitivity analysis allowed us to assess the generalizability of our main study findings. There were no significant differences among clinic characteristics by performance status in the sensitivity analysis.”

Importantly, this study is not without limitations, including the varied quality and approaches in implementing EBIs across the different clinics studied. Even further, the data used for this study did not provide insight into how the EBIs were implemented or whether clinic factors can act collaboratively with EBIs to stimulate screening rate increases.

“The CRCCP is a public health program, not a research study, and we determined that routine collection of detailed information on how EBIs are implemented would be burdensome to participating clinics,” explained the study authors.

Moving forward, the investigators suggested that these findings can help inform future implementation of the CRCCP. Notably, the The Centers for Disease Control and Prevention has already released a new 5-year CRCCP funding opportunity that instructs recipients to implement multiple EBIs in each partner clinic, develop and follow a protocol for the delivery of accurate EBI implementation support, and recognize screening champions.


Sharma KP, Leadbetter S, DeGroff A. Characterizing clinics with differential changes in the screening rate in the colorectal cancer control program of the centers for disease control and prevention. Cancer. December 10, 2020. doi:10.1002/cncr.33325