Improving Equitable Cancer Screening Through Health System Change

Dr. Nicole Rochester:

So Dr. May, in your work, to expand colorectal cancer prevention and screening, what are some system-level changes, whether within the health systems or through policy, that are needed in order to make evidence-based testing and care more consistent and accessible for diverse populations?

Dr. Folasade May:

I think you actually bring up a really important point there, because when we talk about interventions to address inequities, I tend to break them up into groups. We have patient-focused interventions, we have provider-focused intervention, health system-focused interventions, and then we also have interventions that are more community or population-based. And, you know, ideally, you have interventions that are affecting all of those stakeholders, but my work actually very often focuses on those system-level interventions. How can you make small tweaks or changes within a health system to help close gaps or variation and address inequities?

There are two specific examples I’ll use of how I think health system-level changes can address variation in care. The first is using automation in a health system, and the other is using standard education or information in a health system. So, in my lab, part of our team focuses on quality improvement. And we do that at the health system level here at UCLA Health. And what we’ve been able to do over time is make changes to our electronic health record and to our system that help offset the work that a primary care provider needs to do. A primary care provider is responsible for all health maintenance, which is overwhelming for them to do, sometimes in a 15-minute appointment. So what we can do is use things like the electronic health record to not only remind providers when critical things are due, but also directly interface with the patient.

So that automization example at UCLA Health is that we automate our colorectal cancer screening tests. We actually asked patients, we tell them, you’re due for screening now, do you want a colonoscopy, or do you want us to mail you a stool-based test? And then we wait for the patient to answer through the patient portal, and we either schedule that colonoscopy, or we mail them that kit, to do the test at home. So that automation is really helpful because it helps remove a potential bias from a situation where maybe a provider is looking at a patient and making a judgment as to whether the patient will complete the screening test and not recommending it, which sometimes, unfortunately, we see with our patients of color. And it’s also helping offset the primary care doctor by removing that from the laundry list of things that they have to cover in a primary care appointment. So that’s an example of automation in a health system to reduce variation. The other example is standardized information or education. So, when patients reach a certain age, i.e., they are eligible for breast cancer screening, are eligible for colorectal cancer screening, we can start automating information, our shared decision-making tools, or flyers to them either through the mail or through patient portals. And that can help patients prepare for upcoming conversations with their provider, or even go ahead and take care of it without the involvement of the primary care provider.  So, these are just two examples, automization and standard education that we can use at a health system level to close those gaps and get patients on the same page with their access. 

Dr. Nicole Rochester:

Those are phenomenal examples. Thank you. Thank you so much for sharing that. I feel like everybody should be doing that. Those are great examples.