Evaluation of a National Quality Improvement Collaborative for Improving Cancer Screening
Authors: Joung Rachel Hae-Soo , Mullett Timothy W. , Kurtzman Scott H. , Shafir Sarah , Harris James B. , Yao Katharine A. , Bilimoria Karl Y. , Cance William G. , Nelson Heidi ,   Return-to-Screening Quality Improvement Collaborative, Abedi Ali , Acharya Sheetal , Adams Karen T. , Agarwal Rishi , Agarwal Sachin , Ahmad Rima , Albaneze Philip , Aldis Kimberly , Allen Ahkeel , Allman Shayla , Alsen Meiling , Ansteth Mindy , Appiah Angela A. , Arentz Candy , Arias Amanda (Lori) , Armetta Christine , Arnold Alicia H. , Arsene Camelia , Arthur Karen , Ashton Brandon , Atassi M Bassel , Attia Sameh , Bahna Heidi , Bailen Laurence , Baker Thelma , Balan Stefan , Balis Amy , Balsley Anne , Barajas Denise , Barone Julie L. , Batchelor Brett , Bates Elizabeth , Bayliss Trevor , Beck Susan , Bennett Brandon , Bennett Ryan , Bennett Nathan , Bensenhaver Jessica , Berby-Todd Jane , Berrocal Julian , Bertoni Danielle , Bevan Alison , Bhatti Rabia , Bier-Laning Carol , Blackwood Margaret M. , Blake Kenneth , Blankner Joanna G. , Blansfield Joseph A. , Blaszkowsky Lawrence , Blonigen Brian , Bloom David , Boatsman Justin , Boggs Jonathan , Bold Richard , Bollinger Deborah , Bolton Cheryl , Boolbol Susan , Boone Greg , Borges Lawrence , Bouton Michael , Bovest Carol L. , Bowman Seitz Tara , Boyer Carol , Boyle Colton , Bracho Francisco A. , Bragg Autumn , Branton Susan , Breslin Tara M. , Brock Melissa N. , Broder Arkady , Brown Christine , Brown Bradley , Brown Holly , Brown Lisa M. , Brown Richard , Bruce Laura , Bruce Sara , Bruton Catherine , Bryant Karen , Burak William , Burgers Jessica , Busch Kristin , Caba David , Cain James , Campbell Matthew , Campo Cynthia , Canavan Lynn , Cannick Leander , Caputo Paula , Carr H. Janelle , Casteel Christina , Cattaneo Stephen , Cecil Austin , Celano Paul , Chambers Karinn , Chambers Stella , Chin Janet , Christian M Kathleen , Chu Crystal , Church Allison , Clark Jamie , Clark Lynne P. , Clements Marsha , Cohen Seth , Cole Cathy J F , Colemire Danielle , Compton Julia , Connery Cliff P. , Constanza-Guaqueta Delia , Contreras Stacey , Coon Alan B. , Copelen Kathleen L. , Corral Javier , Cosio Rosa , Costas Kimberly E. , Cox April , Cox John A. , Crane Erin P. , Crotzer David , Cruz Celeste G. , Cygan Angelique , Cyphers Lisa , Czerlanis Cheryl , Dale Paul S. , Danak Shivang , Dang Pragya A. , Darcourt Jorge G. , Davuluri Raj , Day Barbara , DeAntonio Phyllis , Der Yamile , DiAddezio Nelah , Dietrich Leah L. , Diller Edma , Dodge Tanya , Domenech Gabriel , Donovan Diana , Dubil Elizabeth , Dunn Gary , Ebling Lindsay , Edsall Bonnie , Eftimie Bogdan , El Mouallem Nemer J. , Eladoumikdachi Firas , Elliott Joy , Elliott Katie , Ellis Melissa , Endo Kenneth , England Trisha , Ennis Carrie , Everhart Toni , Evins Amy , Facktor Matthew A. , Fadel Celine , Farrell Michael , Fawley Diane , Feldman Elizabeth D. , Finan Michael A. , Fintel Andrew , Fleshman James , Fogarty Sara P. , Fontanilla Hiral , Fontenot Eric C. , Foran Jon , Foss-Blizard Chaundra , Frank James , Franz Julie , Freeman Lu , Freter Rolf , Fried Steven , Gabriel Ryan , Galbraith Joan , Garcia Johanny , Gardner Kim , Geary Karen , Gemmel David J. , Gerlach Jessica , Ghee Lauren , Ghisoli Maurizio , Giannone Deborah , Gibbons Courtney , Gillis Paul , Gilmore Denis , Gonzalez Victor J , Gooley Leann , Gorrell Christine , Grady Sally , Grew David , Grisby Shaunda , Guerra Carmen E. , Guerriero Jacqueline , Gupta Kunal , Gynn Michael , Hafertepen Laura , Hale Christy , Hallenbeck Ryan , Hals Ladonna , Hammons Emmy L. , Haramati Linda B. , Harper Natalie W. , Harris James , Harrison Meredith A. , Harrison Miranda , Hassapis John , Haverlock Betty , Hawley Aimee , Hayden Theresa , Hayes Cherylle , Hayes Dawn M. , Headen Carole , Hehnly Erika , Heikens Sarah , Heinzman Stephen , Herring Mary E. , Hill Michelle , Hirner Patricia , Hobbs Kiera , Hordyk Heidi , Horning Neil , Howard Donna , Huang Kan , Hughes Corilynn , Hughes Jenevieve , Huibregtse Carol , Huitt Nancy , Hunsucker Laura , Inverso Tina , Irwin Tonia , Isbell Melanie , Jabbour Nicola , Jackson Mia L. , Jackson Raymond , Jacob-Perez Sherly , Jafri Nazia , Jahania Salik , Jarrett Adam , Jenkinson Scott , Johnson Richard , Johnson Anna , Johnson Dianne , Johnson Patricia , Johnston Catherine , Jones Roberta , Jones Susan , Joseph Joyce , Joseph Natalie E. , Joyner Robert L. , Juarez-Perez Maria , Kaczmarski Kimberly , Kakani Vijaya , Kamran Amir , Kanaan Samer , Kang Tyler , Kannarkatt Joseph , Kanneganti Shalini R. , Kantharaj Belagodu , Kaufman Howard , Keeler Vickie , Keiser Shanna , Kennedy Malissa , Khan Iftekhar , Khan Raza , Kibel Lesley P. , Kiernan Marianne , Kim Brian , Kinnaird Adriene , Kipping-Johnson Kristen L. , Kirkland Peggy , Kirshnan Sandeep , Klaff Lindy , Kloss Robert , Klotz Jeffrey K. , Knight Susan , Koch Julie , Kocheril Paul G. , Kodali Dhatri , Kohli Manpreet , Koko Isoken , Kong Amanda L. , Kozyreva Olga , Kraft Lorei A. , Krisher Stacy , Kruse Edward J. , Kupstas Amanda , Kurian Mini , Kwait Rebecca , Lan Cynthia , Lanciano Rachelle , Lannon Wendy , Laster Sydney R. , LaTrenta Linda R. , Law Suzanne A. , Le Isabelle , Lean Nancy , Leatherbury Keith , Lee Jacqueline , Leete Tyler , Legenza Mary , Leung Winifred K. , Li Jongming , Likhacheva Anna , Lingerfelt Brian , Llaguna Omar H. , Longo Laura , Loop Melissa , Lopez Nicholas , Loporchio Nancy , Lowney Jennifer , Lozoraitis Carisa , Lu Kit Y. , Lue Deborah , Lush Richard , Luyimbazi David T. , Lyons Debra , Macedo Francisco I. , Machenzie Michelle , Mack David , Mack Julie , MacVicar Jessica , Mah Kathleen L. , Mahoney Kathryn , Makani Neeharika S. , Makower Della , Malad Salman , Maldonado Cynthia , Malik Farhana , Malone Angie , Mantha Suparna , Marczak Kristina , Margolis Nathaniel , Mashanic Kathleen , Mathison Jill , Mauzy Tiffany , Maxwell Leslie , McAllaster Jennifer , McCarthy Caitlin , McClune Jason , McColgan Jennifer K. , McCusker Teresa , McDaniel Dana , McFayden Lynette , McGivney Randall , McGovern Kerri , McKeever Hannah , McManus Susan , McNair Kate , McNeil Heather , McRae Jennifer , Medrano Consuelito A. , Mehta Pallav , Merrigan Tricia , Meyers Eva , Mickey Suzanne , Miller Jackie , Miller Luke , Miller Stephanie , Mink Tara , Miranda Jodi , Mitchell Mary M. , Monroe Julie , Moore Joyce , Morin-Ducote Garnetta , Moritz Troy , Morris Paul T. , Mukherjee Sumit , Mullally Sean D. , Mulligan Margaret , Mullins David A. , Mullins Mary , Munoz Ivonne , Murdock Jeremy J. , Myers Stacie N. , Nair Sindhu , Nandamuri Kiran , Nicholls Joanne , Nick Donna , Nish Andrew , Nowell Andrew , Nowell Kerri , O'Connor Lynn M. , O'Neill Judy , O'Riordan Moira , Ogunkunle Roselyn , Opsasnick Margo M. , Ortiz Cindy A. , Osgood Rebecca , Oxenberg Jacqueline , Page Brandi R. , Palmer Jacquelyn A.V. , Parikh Dhaval K , Park David J. , Partin Jessica , Passwater Chelsea , Patel Mita , Patrick Jilma , Patterson Shauntee , Pearson Laura , Peiffer Susan , Peralta Elizabeth , Peterson Mary , Pettus Benjamin , Pezzulo John , Pfarr Megan , Phelps Connie , Phillips Lacy , Pick Matthew , Piephoff James , Pinkston Jodee , Piper Jessica , Pollak Stanley B. , Ponec Robert , Popalzai Muhammad J. , Pories Susan E. , Prieto Robert , Proctor Kerry , Provost Karla , Prow Debra , Puc Matthew , Purdon Mary , Quaranta Brian P. , Quinlan-Davidson Sean , Rabines Alfredo , Rahman Rakhshanda L. , Ramasubbaiah Rashmi , Ramírez-Solá Maricarmen , Randolph David , Raskin Elizabeth R. , Rasmussen Linda , Rasmussen Nicole , Rasmussen Ronald , Reed Clinta C. , Reese Shellee , Regis Shawn M. , Reilly James , Reitherman Richard , Reneau Curtis , Renfroe Connie , Renn Carol , Reyna Chantal , Rieger-Christ Kimberly , Ringer Rochelle , Rizack Tina , Rizwan Uzma , Robinson William R. , Robles-Rodriguez Evelyn , Rogers Ethan S. , Ronk Melissa , Rossidis George , Rovito Marc A. , Roy Abhik , Roybal Lisa , Ruggiero George , Ruskin Rachel , Ryan Jessica , Sachdeva Kush , Saffie Anne , Sall Noura , Salters Dana , Sanchez Juan F. , Sandborn Joy , Sarap Michael D. , Sarap Michael , Sasaki Jennifer , Schallenkamp John M. , Schilder Lawrence E. , Schlesinger Kimberly W. , Scholl Jackie , Scoppetuolo Michael , Scott Jeanie , Sexton Will , Seydel Anna , Shackour Mazin , Shah Apurva , Shah Minal , Sharif Suhail , Shaw Camilla M. , Shehata Andrew , Shelton Charles H , Shields Reve , Shilad Sabrina , Shively Eugene , Shriner Michelle , Siebentritt Joel R. , Singhal Shyamali , Sinha Shreya , Sinha Suman , Slotkin Jaime , Smith Kaylene , Smith Sarah , Smith-Marrone Stephanie , Sobel Lawrence D. , Sobolewski Anna , Sobolewski Robin , Solomon Naveenraj , Songy Tonya C. , Sonnier Fran , Sorenson Leslie , Sorto Juan C. , Souza Will , Spector David M. , Spigelman Zachary , Steitz Barbara , Stephens Clifford , Stewart Sheelagh , Stipec Gretchen , Stith Brittany , Street Holly , Subramanian Janakiraman , Sumrall Maria , Sundermeyer Mark , Syed Ali , Szwerc Michael , Tanner Laura , Tatum Tracey , Taveira Roxana , Taylor Michael , Taylor Julia , Teal Christine B. , Tello-Skjerseth Christina , Terhaar Kenneth , Terhar Margaret , Thind Ravneet , Thomas Kendra L. , Thompson Nancy , Thomson Carey C. , Tieu Brandon , Toke Madhavi , Tomita Megumi , Tomkovich Kenneth , Tong Elisa , Tothy Peter , Tran Maria , Travis-Soper Kay , Trikha Gaurav , Trikha Guarev , Vasnani Raj , Veeramachaneni Nirmal , Veerapaneni Annabelle , Ventura-Cullen Deanna , Vester Dee , Vinsky Julia , Visioni Anthony , Vlaminck Lindsay , Wadhera Akhil , Wagner Jamie , Waits Brandy , Walenga Sharon , Walker Michael , Wallace Lucy B. , Wallace James A. , Ward Marie , Warmington Kirsten , Wasley Richard , Watson Kimberly L. , Watson Wendy , Waxman Jonathan , Weathersby Robert , Weaver Elizabeth A. , Weber Mary E. , Weiselberg Christine , Wesen Cheryl , Wexler Ann , Weyer Darlene , White Paul , White Christina , Whitefield Karolina , Wilkinson Reagan , Willey James C. , Williams Verneetta , Wilson Jason P , Witt Virginia M. , Wold Howard , Woodford Deb , Woomer Scott , Wray Justin W. , Yeh Karen , Yoon-Flannery Kahyun , Zera Richard , Zlomke Michael , Zummo Kirby , Zwicky Karen 
Published: November 2022

Importance

Cancer screening deficits during the first year of the COVID-19 pandemic were found to persist into 2021. Cancer-related deaths over the next decade are projected to increase if these deficits are not addressed.

Objective

To assess whether participation in a nationwide quality improvement (QI) collaborative, Return-to-Screening, was associated with restoration of cancer screening.

Design, Setting, and Participants

Accredited cancer programs electively enrolled in this QI study. Project-specific targets were established on the basis of differences in mean monthly screening test volumes (MTVs) between representative prepandemic (September 2019 and January 2020) and pandemic (September 2020 and January 2021) periods to restore prepandemic volumes and achieve a minimum of 10% increase in MTV. Local QI teams implemented evidence-based screening interventions from June to November 2021 (intervention period), iteratively adjusting interventions according to their MTVs and target. Interrupted time series analyses was used to identify the intervention effect. Data analysis was performed from January to April 2022.

Exposures

Collaborative QI support included provision of a Return-to-Screening plan-do-study-act protocol, evidence-based screening interventions, QI education, programmatic coordination, and calculation of screening deficits and targets.

Main Outcomes and Measures

The primary outcome was the proportion of QI projects reaching target MTV and counterfactual differences in the aggregate number of screening tests across time periods.

Results

Of 859 cancer screening QI projects (452 for breast cancer, 134 for colorectal cancer, 244 for lung cancer, and 29 for cervical cancer) conducted by 786 accredited cancer programs, 676 projects (79%) reached their target MTV. There were no hospital characteristics associated with increased likelihood of reaching target MTV except for disease site (lung vs breast, odds ratio, 2.8; 95% CI, 1.7 to 4.7). During the preintervention period (April to May 2021), there was a decrease in the mean MTV (slope, −13.1 tests per month; 95% CI, −23.1 to −3.2 tests per month). Interventions were associated with a significant immediate (slope, 101.0 tests per month; 95% CI, 49.1 to 153.0 tests per month) and sustained (slope, 36.3 tests per month; 95% CI, 5.3 to 67.3 tests per month) increase in MTVs relative to the preintervention trends. Additional screening tests were performed during the intervention period compared with the prepandemic period (170 748 tests), the pandemic period (210 450 tests), and the preintervention period (722 427 tests).

Conclusions and Relevance

In this QI study, participation in a national Return-to-Screening collaborative with a multifaceted QI intervention was associated with improvements in cancer screening. Future collaborative QI endeavors leveraging accreditation infrastructure may help address other gaps in cancer care.