Primary Care Collaboration to Improve Diagnosis and Screening for Colorectal Cancer Gordon D. Schif, MD; Trudy Bearden, PA-C; Lindsay Swain Hunt, MEd; Jennifer Azzara, MM; Jay Larmon, MBA; Russell S. Phillips, MD; Sara Singer, PhD, MBA; Brandon Bennett, MPH; Jonathan R. Sugarman, MD, MPH; Asaf Bitton, MD, MPH; Andrew Ellner, MD Background: Colorectal cancer (CRC) is a leading cause of cancer death, reducible by screening and early diagnosis, yet many patients fail to receive recommended screening. As part of an academic improvement collaborative, 25 primary care practices worked to improve CRC screening and diagnosis. Methods: The project featured triannual learning sessions, monthly conference calls, practice coach support, and monthly re- porting. The project phases included literature review and interviews with national leaders/organizations, development of driver diagrams to identify key factors and change ideas, project launch and practice team planning, and a practice improvement phase. Results: The project activities included (1) inventory of barriers and best practices, (2) driver diagram to drive improve- ments, (3) list of changes to try, (4) compilation of lessons learned, and (5) five key changes to optimize screening and follow- up. Practices leveraged prior transformation eforts to track patients for screening and follow-up during and between ofce visits. By mapping processes, testing changes, and collecting data, sites targeted opportunities to improve quality, safety, ef- ficiency, and patient and care team experience. Successful change interventions centered around partnering with gastroenterology, engaging leadership, leveraging registries and health information technology, promoting alternative screening options, and partnering with and supporting patients. Several practices achieved improvement in screening rates, while others demon- strated no change from baseline during the 10-month testing and implementation phase (July 2014–April 2015). Conclusion: The collaborative efectively engaged teams in a broad set of process improvements with key lessons learned related to barriers, information technology challenges, outreach challenges/strategies, and importance of stakeholder and patient engagement. D espite its status as the second leading cause of cancer death in the United States and a leading cause of mal- practice claims, with availability of a number of proven screening modalities, colorectal cancer (CRC) diagnosis and screening remains suboptimal in practice. 1–6 Screening methods can detect cancer at an early and more treatable stage and prevent cancers that may arise from polyps that can be detected and resected. An estimated 60% of CRC deaths in the United States are preventable with regular testing of adults ages 50 to 75 years, but one third of the popula- tion has not been tested as recommended, with even lower screening rates in some states and underserved populations. 1,7–13 Screening and diagnostic testing of higher- risk patients (for example, patients with rectal bleeding, positive family history) is also suboptimal. 8,9 Primary care is a crucial catalyst for promoting CRC screening 10 and cre- ating population-based, team-enabled screening programs within primary care sites can increase rates of screening. 11 Despite large-scale public awareness campaigns to en- courage screening, there is clearly a need for health care delivery organizations, particularly those delivering primary care, to pursue improvement strategies to increase CRC screening and timely diagnosis. 12,13 To make significant pro- gress on CRC at a time of great demand for overall improvements in the efciency and efectiveness of care, or- ganizations must address myriad barriers and challenges that patients and clinicians encounter in navigating CRC screen- ing and diagnostic modalities. 1,14,15 In 2012 the Harvard Medical School Center for Primary Care partnered with 19 Harvard-afliated primary care prac- tices afliated with six major health systems to create a learning community dedicated to improving the experience of care for patients, staf, clinicians, and trainees in primary care, as well as the quality and cost of care. 16 This efort, called the Academic Innovations Collaborative (AIC), focused on eight Change Concepts for Practice Transformation, 17 and during an initial 24-month period (July 2012–June 2014) the participating practices achieved measurable improve- ments in core infrastructure domains for practice improvement and statistically significant improvements in team dynam- ics and trainee experience. 18 At the end of these two years, the collaborative had the opportunity to build on the mo- mentum by continuing for a second two years (July 2014– June 2016) supported by funding from CRICO, the nonprofit medical malpractice insurer serving the Harvard medical community. This phase of the collaborative, called the AIC Comprehensive, Accessible, Reliable, Exceptional and Safe (CARES) Initiative, was built on the foundation of team-based care to improve patient safety in participat- ing practice sites and systems by reducing missed and delayed 1553-7250/$-see front matter © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jcjq.2017.03.004 ARTICLE IN PRESS The Joint Commission Journal on Quality and Patient Safety 2017; ■■:■■–■■