Active Choice to Increase Cancer Screening Rates
Esther Hsiang, MD, MBA
Susan Day, MD, MPH
Kevin Volpp, MD, PhD
Dylan Small, PhD
Leonard Davis Institute of Health Economics
National Institute on Aging
Cancer is a leading cause of death in the United States.
High-value screening tests such as colonoscopy and mammography can improve early cancer detection, which is crucial as it can often lead to improved patient outcomes. Unfortunately, these tests are often underutilized.
We implemented an active choice intervention using the electronic health record (EHR). During clinic visits, physicians and medical assistants were prompted to confirm patient eligibility for colonoscopy or mammography and actively choose to accept or cancel an order for the screening.
The active choice intervention increased orders for colonoscopy and mammography tests. The intervention was also associated with improved patient completion of colonoscopies. Based on these findings, the health system decided to implement the approach across all primary care clinics in the Penn Medicine network.
Upon expansion, we refined the active choice intervention to only deliver prompts to medical assistants, who then templated orders for physicians to review and sign. Compared to control practices, we saw a significant increase in clinician ordering of colonoscopy and mammography at expansion sites but no significant change in patient completion of either screening at the one-year follow-up point.
Another study conducted by our team revealed that clinician ordering of cancer screening tests significantly decreased as the clinic day progressed, as did screening completion within one year if the primary care appointment time was later in the day. Future interventions targeting improvements in cancer screening should consider how time of day may influence behaviors.