This educational outreach program for primary care providers encourages physicians to recommend and perform complete diagnostic evaluation for colorectal cancer among patients with an abnormal screening fecal occult blood test (FOBT) result. Patients are mailed an FOBT kit annually as a part of a screening program, but not all patients with an abnormal result receive a complete diagnostic evaluation, which includes either a colonoscopy or combined flexible sigmoidoscopy plus barium enema X-ray. Provider education includes a presentation about colorectal cancer screening and the barriers to complete diagnostic evaluation. An internal chart audit is performed to determine whether complete diagnostic evaluations were conducted as needed, and participating providers receive a personalized letter about their audit results. In a follow-up phone call barriers to complete diagnostic evaluation are identified, and solutions to overcome barriers are discussed.

The goal of this program is to increase recommendation and performance rates of complete diagnostic evaluation for colorectal cancer in primary care practices.

The program was evaluated using a group randomized controlled trial comparing the intervention group with a control group that received only the FOBT screening program. The intervention group significantly increased the number of patients with an abnormal FOBT result receiving a recommendation for complete diagnostic evaluation, as compared to participants (OR = 2.28; 95% CI 1.37-3.78). The number of patients receiving a complete diagnostic evaluation increased significantly in the intervention group when compared to the control group (OR = 1.63; 95% CI 1.06-2.50).