An LG Health Innovation Accelerator project winner, “Screen On Time,” communicates with patients to improve screening rates for colorectal cancer. 

A photo of a person touching a smartphone screen; to the write is a graphic indicating unread messages March is Colorectal Cancer Awareness Month, when adults are reminded to schedule a screening for prevention and early detection. Penn Medicine Lancaster General Health is amplifying that message with the help of a texting platform called Screen On Time. By sending patients text reminders, the project has increased screening rates.

Innovation Driving Improvement

Thelmelis Abreu, a design strategist at the Center for Health Care Innovation at LG Health, said the project, initiated in 2020, was one of the first selected by the Center’s Innovation Accelerator Program (IAP). The IAP provides funding and support to develop, test, and implement new ideas for improving health care delivery and outcomes.

Brian Young, MD, family physician and medical director of Care Transformation and Primary Care IT at LG Health, championed the project and Tara K. Casher, administrative director for the LG Health GI/General Surgery Service Line, served as executive sponsor.

Young’s goal was to improve colorectal cancer (CRC) screening rates at LG Health which were 72.8 percent in 2020. The quality metric set by the American Cancer Society was 80 percent, leaving a care gap of 20,000 patients.

Abreu and her colleagues worked closely with Young’s team to better understand the barriers to screening. They knew that patients who had suffered a form of trauma could be sensitive to invasive procedures, such as colonoscopy. Requiring another person to drive them to and from the procedure was a problem for some patients, while fear of a bad result was a deterrent for others. Surprisingly, prep anxiety was less a barrier to colonoscopy than the process of scheduling the appointment, with its long questionnaire.

Updated Reminders, Options – and Results

Abreu and the IAP team knew reminders were an effective way to boost compliance with screening recommendations. To make that process more efficient, they centralized patient outreach for CRC reminders – a responsibility that previously fell on primary care practices.

They developed an automated report to identify patients who meet screening criteria and send those patients a text message in English or Spanish on their birthday.

The Penn Medicine-branded FIT Kit colorectal screening box; behind it is a brochure titled “Screen on Time” “We intentionally include the patient’s and provider’s names as points of personalization, so the message doesn’t look like spam and is harder to ignore,” Abreu said. 

Patients are first offered a colonoscopy, to be scheduled through Regional GI, the practice affiliated with LG Health. If they decline, they are mailed a fecal immunochemical test (FIT), a free, non-invasive home test to detect hidden blood in the stool. While colonoscopy remains the gold standard for CRC testing, FIT is a convenient alternative that meets screening requirements. To enhance compliance, the IAP team rebranded the FIT kit with a more attention-grabbing package and easier-to-follow instructions.

Since implementing the Screen On Time reminder program throughout LG Health in September 2021, screening rates have steadily climbed to 75.1 percent, exceeding LG Health’s initial screening goal of 74.1 percent.

The project’s leaders are involved in a CRC screening improvement group led by Shivan Mehta, MD, MBA, MSHP, associate chief innovation officer at Penn Medicine and an assistant professor of Gastroenterology and Medical Ethics and Health Policy, to share best practices like these throughout Penn Medicine. They believe innovations like these can be applied elsewhere, too.

“Automating patient reminders and using text messaging as the platform, as opposed to letters and phone calls, have led to significant improvements in patients completing their colon cancer screening and reduction in staff time,” said Young. “We are actively planning to spread this idea to other important topics such as breast cancer screening and well-child checks.”

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