PS2-31: Implementation of Universal Lynch Syndrome Screening in an Integrated Health Care Delivery System.

Kauffman T, Morse M, Reiss J, Davis J, Young C, Esterberg E, McGinley C, Goddard K.

Abstract

Background/Aims Lynch syndrome (LS) is a hereditary form of colon cancer that is present in about 3% of colon cancer patients. Seventy-one percent (71%) of the NCI Comprehensive Cancer Centers conduct universal LS screening, while only 15% of the community hospital cancer programs regularly screen for LS. A previous 7 site HMORN study found that none of those sites were performing universal LS screening, and fewer than 4% of colon cancer patients were tested for LS. Currently, fewer than 5% of patients diagnosed with colorectal cancer (CRC) at Kaiser Permanente Northwest (KPNW) receive Lynch syndrome screening. KPNW relies on provider or self-referrals to Medical Genetics for appropriate LS screening. How do we improve access to LS screening? Methods Through a randomized controlled trial, we are evaluating the effectiveness of universal LS screening compared to usual care. We began recruitment in February 2012. We will determine the types and impacts of system barriers on effective LS screening implementation. Results Stakeholder engagement was challenging to obtain due to variation in knowledge of LS but has proven crucial to success. Cultivating relationships generated willingness and interest among stakeholders in solving issues. The pathology procedure required extensive coordination for appropriate specimen handling and timely testing. The algorithm to identify eligible patients among those scheduled for bowel surgery daily from the EMRs required revisions to locate patients correctly. We will share the lessons we have learned in implementing a universal screening program in the health plan. Conclusions So far, universal LS screening implementation has yielded both successes and hurdles. Developing strong relationships with stakeholders has led to their active participation in problem-solving. The pathology procedure required extensive coordination for specimen handling and testing. Developing methods to quickly identify issues with sample processing and testing improved turnaround time. Patients had to be identified quickly in the EMR given the often short time from surgery scheduling to surgery completion. Evaluation of the implementation steps will help determine best strategies for successful universal LS screening. Since LS screening rates are low at many HMORN sites, we hope that the lessons we learned will inform future implementation efforts.