Impact of a resident-led quality improvement intervention on colorectal cancer screening completion at a federally qualified health center.

Abstract

e23306 Background: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality, yet screening rates remain suboptimal, particularly in underserved populations. At a Federally Qualified Health Center (FQHC) in Central Texas, patients face barriers including limited health literacy, logistical challenges, and missed opportunities for preventive counseling. Resident physicians, often the first point of contact for these patients, are positioned to promote preventive health behaviors. Prior studies demonstrate that physician-led counseling improves cancer screening adherence. Our objective was to improve CRC screening completion rates at FQHC by 20% over baseline through resident-led educational and patient follow-up intervention. Methods: Internal medicine residents participated in a one-time educational session on CRC screening guidelines, stool-based test options (with emphasis on the InSure FIT test), and patient-centered communication strategies. Visual reminders were posted in resident work, and a standardized “.crcscreening” dot phrase was created to reinforce consistent documentation. Residents conducted structured patient follow-up by reviewing lists of patients with incomplete screenings, contacting them via phone or MyChart to address barriers, and documenting reasons for non-completion in an Excel-based tracking tool. A designated clinic nurse supported coordination. Baseline and post-intervention data on resident counseling behaviors, confidence, screening orders, and CRC screening completion rates were collected. Resident panel CRC completion rates were extracted from the Epic electronic health record at baseline and one quarter post-intervention. Results: All 64 residents completed the educational intervention. Based on survey data, the proportion of residents who always counseled patients on CRC screening increased from 46.4% pre-intervention to 98.4% post-intervention (p < 0.0001). Similarly, residents who reported being comfortable explaining the InSure FIT test increased from 42.0% to 95.3% (p < 0.0001). Of the 64 residents who completed the intervention, 38 were assigned continuity clinics at the FQHC. Among 38 residents with paired pre- and post-intervention patient panel data, mean CRC screening completion rates increased from 47% at baseline to 59% one quarter after the intervention (+12%, p < 0.001). Conclusions: This resident-driven initiative illustrates a practical, scalable strategy to improve CRC screening in an underserved population. By integrating provider education, workflow tools, and structured patient follow-up, this intervention achieved significant gains in both resident counseling behaviors and patient-level CRC screening completion. This model advances health equity, promotes early cancer detection, while embedding preventive care into routine practices.