Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial

Autores
Irazola, Vilma; Santero, Marilina; Sanchez, Mario; Tristao, Ignez; Ruiz, Juan Ignacio; Spira, Cintia; Ismael, Julia; Cavallo, Ana Soledad; Gutierrez, Laura; Mazzaresi, Yanina; Nadal, Ana Maria; Garcia Elorrio, Ezequiel
Año de publicación
2023
Idioma
inglés
Tipo de recurso
artículo
Estado
versión publicada
Descripción
Background Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates remain below 20% in the country.Methods We conducted an 18-month, two-arm, pragmatic cluster-randomised controlled trial evaluating the effect of a quality improvement intervention, based on the Plan-Do-Study-Act cycles, considering barriers andcatalysts to articulate theory and practice, to increase CRC screening rates using FITs at primary care level. The study involved ten public primary health centres in Mendoza province, Argentina. The primary outcome measure was the rate of effective CRC screening. Secondary outcomes were the rate of participants with a positive FIT, tests with invalid results and the rate of participants referred for colonoscopy.Results Screening was effective in 75% of the participants in the intervention arm vs 54.2% in the control arm, OR 2.5 (95% CI 1.4 to 4.4, p=0.001). These results remained unchanged after adjusting for individual demographic and socioeconomic characteristics.Regarding secondary outcomes, the overall prevalence of positive tests was 17.7% (21.1% in the control arm and 14.7% in the intervention arm, p=0.3648). The overall proportion of participants with inadequate test results was5.2% (4.9% in the control arm vs 5.5% in the intervention arm, p=0.8516). All the participants with positive tests were referred for colonoscopy in both groups.Conclusions An intervention based on quality improvement strategies proved to be highly successful in increasing effective CRC screening in Argentina’s primary care setting within the public healthcare system.
Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Santero, Marilina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Sanchez, Mario. Inter-American Development Bank; Estados Unidos
Fil: Tristao, Ignez. Inter-American Development Bank; Estados Unidos
Fil: Ruiz, Juan Ignacio. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Spira, Cintia. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Ismael, Julia. Ministerio de Salud. Instituto Nacional del Cáncer; Argentina
Fil: Cavallo, Ana Soledad. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Mazzaresi, Yanina. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; Argentina
Fil: Nadal, Ana Maria. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; Argentina
Fil: Garcia Elorrio, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Materia
Early Detection of Cancer
Colorectal Neoplasms
Cluster trials
Nivel de accesibilidad
acceso abierto
Condiciones de uso
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
Repositorio
CONICET Digital (CONICET)
Institución
Consejo Nacional de Investigaciones Científicas y Técnicas
OAI Identificador
oai:ri.conicet.gov.ar:11336/237640
Acceder
id CONICETDig_cfe25c18b931f819d38f2c910fe27d0d
oai_identifier_str oai:ri.conicet.gov.ar:11336/237640
network_acronym_str CONICETDig
repository_id_str 3498
network_name_str CONICET Digital (CONICET)
spelling Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trialIrazola, VilmaSantero, MarilinaSanchez, MarioTristao, IgnezRuiz, Juan IgnacioSpira, CintiaIsmael, JuliaCavallo, Ana SoledadGutierrez, LauraMazzaresi, YaninaNadal, Ana MariaGarcia Elorrio, EzequielEarly Detection of CancerColorectal NeoplasmsCluster trialshttps://purl.org/becyt/ford/3.3https://purl.org/becyt/ford/3Background Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates remain below 20% in the country.Methods We conducted an 18-month, two-arm, pragmatic cluster-randomised controlled trial evaluating the effect of a quality improvement intervention, based on the Plan-Do-Study-Act cycles, considering barriers andcatalysts to articulate theory and practice, to increase CRC screening rates using FITs at primary care level. The study involved ten public primary health centres in Mendoza province, Argentina. The primary outcome measure was the rate of effective CRC screening. Secondary outcomes were the rate of participants with a positive FIT, tests with invalid results and the rate of participants referred for colonoscopy.Results Screening was effective in 75% of the participants in the intervention arm vs 54.2% in the control arm, OR 2.5 (95% CI 1.4 to 4.4, p=0.001). These results remained unchanged after adjusting for individual demographic and socioeconomic characteristics.Regarding secondary outcomes, the overall prevalence of positive tests was 17.7% (21.1% in the control arm and 14.7% in the intervention arm, p=0.3648). The overall proportion of participants with inadequate test results was5.2% (4.9% in the control arm vs 5.5% in the intervention arm, p=0.8516). All the participants with positive tests were referred for colonoscopy in both groups.Conclusions An intervention based on quality improvement strategies proved to be highly successful in increasing effective CRC screening in Argentina’s primary care setting within the public healthcare system.Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Santero, Marilina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Sanchez, Mario. Inter-American Development Bank; Estados UnidosFil: Tristao, Ignez. Inter-American Development Bank; Estados UnidosFil: Ruiz, Juan Ignacio. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Spira, Cintia. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Ismael, Julia. Ministerio de Salud. Instituto Nacional del Cáncer; ArgentinaFil: Cavallo, Ana Soledad. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Mazzaresi, Yanina. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; ArgentinaFil: Nadal, Ana Maria. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; ArgentinaFil: Garcia Elorrio, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaBMJ Publishing Group2023-06info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/237640Irazola, Vilma; Santero, Marilina; Sanchez, Mario; Tristao, Ignez; Ruiz, Juan Ignacio; et al.; Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial; BMJ Publishing Group; BMJ Open Quality; 12; 2; 6-2023; 1-82399-6641CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/url/https://bmjopenquality.bmj.com/content/12/2/e002158info:eu-repo/semantics/altIdentifier/doi/10.1136/bmjoq-2022-002158info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-09-29T10:23:44Zoai:ri.conicet.gov.ar:11336/237640instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-09-29 10:23:44.329CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse
dc.title.none.fl_str_mv Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial
title Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial
spellingShingle Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial
Irazola, Vilma
Early Detection of Cancer
Colorectal Neoplasms
Cluster trials
title_short Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial
title_full Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial
title_fullStr Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial
title_full_unstemmed Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial
title_sort Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial
dc.creator.none.fl_str_mv Irazola, Vilma
Santero, Marilina
Sanchez, Mario
Tristao, Ignez
Ruiz, Juan Ignacio
Spira, Cintia
Ismael, Julia
Cavallo, Ana Soledad
Gutierrez, Laura
Mazzaresi, Yanina
Nadal, Ana Maria
Garcia Elorrio, Ezequiel
author Irazola, Vilma
author_facet Irazola, Vilma
Santero, Marilina
Sanchez, Mario
Tristao, Ignez
Ruiz, Juan Ignacio
Spira, Cintia
Ismael, Julia
Cavallo, Ana Soledad
Gutierrez, Laura
Mazzaresi, Yanina
Nadal, Ana Maria
Garcia Elorrio, Ezequiel
author_role author
author2 Santero, Marilina
Sanchez, Mario
Tristao, Ignez
Ruiz, Juan Ignacio
Spira, Cintia
Ismael, Julia
Cavallo, Ana Soledad
Gutierrez, Laura
Mazzaresi, Yanina
Nadal, Ana Maria
Garcia Elorrio, Ezequiel
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Early Detection of Cancer
Colorectal Neoplasms
Cluster trials
topic Early Detection of Cancer
Colorectal Neoplasms
Cluster trials
purl_subject.fl_str_mv https://purl.org/becyt/ford/3.3
https://purl.org/becyt/ford/3
dc.description.none.fl_txt_mv Background Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates remain below 20% in the country.Methods We conducted an 18-month, two-arm, pragmatic cluster-randomised controlled trial evaluating the effect of a quality improvement intervention, based on the Plan-Do-Study-Act cycles, considering barriers andcatalysts to articulate theory and practice, to increase CRC screening rates using FITs at primary care level. The study involved ten public primary health centres in Mendoza province, Argentina. The primary outcome measure was the rate of effective CRC screening. Secondary outcomes were the rate of participants with a positive FIT, tests with invalid results and the rate of participants referred for colonoscopy.Results Screening was effective in 75% of the participants in the intervention arm vs 54.2% in the control arm, OR 2.5 (95% CI 1.4 to 4.4, p=0.001). These results remained unchanged after adjusting for individual demographic and socioeconomic characteristics.Regarding secondary outcomes, the overall prevalence of positive tests was 17.7% (21.1% in the control arm and 14.7% in the intervention arm, p=0.3648). The overall proportion of participants with inadequate test results was5.2% (4.9% in the control arm vs 5.5% in the intervention arm, p=0.8516). All the participants with positive tests were referred for colonoscopy in both groups.Conclusions An intervention based on quality improvement strategies proved to be highly successful in increasing effective CRC screening in Argentina’s primary care setting within the public healthcare system.
Fil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Santero, Marilina. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Sanchez, Mario. Inter-American Development Bank; Estados Unidos
Fil: Tristao, Ignez. Inter-American Development Bank; Estados Unidos
Fil: Ruiz, Juan Ignacio. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Spira, Cintia. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Ismael, Julia. Ministerio de Salud. Instituto Nacional del Cáncer; Argentina
Fil: Cavallo, Ana Soledad. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Gutierrez, Laura. Instituto de Efectividad Clínica y Sanitaria; Argentina
Fil: Mazzaresi, Yanina. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; Argentina
Fil: Nadal, Ana Maria. Gobierno de la Provincia de Mendoza. Ministerio de Salud Desarrollo Social y Deportes.; Argentina
Fil: Garcia Elorrio, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Efectividad Clínica y Sanitaria; Argentina
description Background Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates remain below 20% in the country.Methods We conducted an 18-month, two-arm, pragmatic cluster-randomised controlled trial evaluating the effect of a quality improvement intervention, based on the Plan-Do-Study-Act cycles, considering barriers andcatalysts to articulate theory and practice, to increase CRC screening rates using FITs at primary care level. The study involved ten public primary health centres in Mendoza province, Argentina. The primary outcome measure was the rate of effective CRC screening. Secondary outcomes were the rate of participants with a positive FIT, tests with invalid results and the rate of participants referred for colonoscopy.Results Screening was effective in 75% of the participants in the intervention arm vs 54.2% in the control arm, OR 2.5 (95% CI 1.4 to 4.4, p=0.001). These results remained unchanged after adjusting for individual demographic and socioeconomic characteristics.Regarding secondary outcomes, the overall prevalence of positive tests was 17.7% (21.1% in the control arm and 14.7% in the intervention arm, p=0.3648). The overall proportion of participants with inadequate test results was5.2% (4.9% in the control arm vs 5.5% in the intervention arm, p=0.8516). All the participants with positive tests were referred for colonoscopy in both groups.Conclusions An intervention based on quality improvement strategies proved to be highly successful in increasing effective CRC screening in Argentina’s primary care setting within the public healthcare system.
publishDate 2023
dc.date.none.fl_str_mv 2023-06
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
http://purl.org/coar/resource_type/c_6501
info:ar-repo/semantics/articulo
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/11336/237640
Irazola, Vilma; Santero, Marilina; Sanchez, Mario; Tristao, Ignez; Ruiz, Juan Ignacio; et al.; Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial; BMJ Publishing Group; BMJ Open Quality; 12; 2; 6-2023; 1-8
2399-6641
CONICET Digital
CONICET
url http://hdl.handle.net/11336/237640
identifier_str_mv Irazola, Vilma; Santero, Marilina; Sanchez, Mario; Tristao, Ignez; Ruiz, Juan Ignacio; et al.; Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial; BMJ Publishing Group; BMJ Open Quality; 12; 2; 6-2023; 1-8
2399-6641
CONICET Digital
CONICET
dc.language.none.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv info:eu-repo/semantics/altIdentifier/url/https://bmjopenquality.bmj.com/content/12/2/e002158
info:eu-repo/semantics/altIdentifier/doi/10.1136/bmjoq-2022-002158
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
eu_rights_str_mv openAccess
rights_invalid_str_mv https://creativecommons.org/licenses/by-nc-sa/2.5/ar/
dc.format.none.fl_str_mv application/pdf
application/pdf
application/pdf
dc.publisher.none.fl_str_mv BMJ Publishing Group
publisher.none.fl_str_mv BMJ Publishing Group
dc.source.none.fl_str_mv reponame:CONICET Digital (CONICET)
instname:Consejo Nacional de Investigaciones Científicas y Técnicas
reponame_str CONICET Digital (CONICET)
collection CONICET Digital (CONICET)
instname_str Consejo Nacional de Investigaciones Científicas y Técnicas
repository.name.fl_str_mv CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas
repository.mail.fl_str_mv dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar
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score 13.070432

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