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A "sludge audit" for health system colorectal cancer screening services

The American journal of managed care, 2023-07, Vol.29 (7), p.e222-e228 [Peer Reviewed Journal]

COPYRIGHT 2023 Intellisphere, LLC ;Copyright MultiMedia Healthcare Inc. 2023 ;ISSN: 1088-0224 ;EISSN: 1936-2692 ;DOI: 10.37765/ajmc.2023.89402 ;PMID: 37523455

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Title:
A "sludge audit" for health system colorectal cancer screening services
Author: Rockwell, Michelle S ; Frazier, Mary C ; Stein, Jeffrey S ; Dulaney, Kimberly A ; Parker, Sarah H ; Davis, George C ; Rockwell, John A ; Castleman, Benjamin L ; Sunstein, Cass R ; Epling, John W
Subjects: Audits ; Behavioral economics ; Cancer ; Colonoscopy ; Colorectal cancer ; Colorectal Neoplasms - diagnosis ; Communication ; COVID-19 - diagnosis ; COVID-19 - epidemiology ; Diagnosis ; Early Detection of Cancer - statistics & numerical data ; Electronic Health Records ; Female ; Health care delivery ; Health care industry ; Humans ; Insurance claims ; Male ; Medical records ; Medical screening ; Methods ; Middle Aged ; Patients ; Primary care ; Review boards ; SARS-CoV-2 ; School lunches ; Sludge ; Southeastern United States ; Task forces
Is Part Of: The American journal of managed care, 2023-07, Vol.29 (7), p.e222-e228
Description: "Sludge," or the frictions or administrative burdens that make it difficult for people to attain what they want or need, is an unexplored health care delivery factor that may contribute to deficiencies in colorectal cancer (CRC) screening. We piloted a method to identify and quantify sludge in a southeastern US health system's delivery of CRC screening services. Mixed methods sludge audit. We collected and analyzed quantitative (insurance claims, electronic health record, and administrative files) and qualitative (stakeholder interviews and process observations) data associated with CRC screening for instances of sludge. Because they contribute to sludge and reduce system capacity for high-value screening, we also evaluated low-value CRC screening processes. Although specific results were likely amplified by effects of the COVID-19 pandemic, the sludge audit revealed important areas for improvement. A 60.4% screening rate was observed. Approximately half of screening orders were not completed. The following categories of sludge were identified: communication, time, technology, administrative tasks, paperwork, and low-value care. For example, wait times for screening colonoscopy were substantial, duplicate orders were common, and some results were not accessible in the electronic health record. Of completed screenings, 32% were low-value and 38% were associated with low-value preoperative testing. There was evidence of a differential negative impact of sludge to vulnerable patients. Our sludge audit method identified and quantified multiple instances of sludge in a health system's CRC screening processes. Sludge audits can help organizations to systematically evaluate and reduce sludge for more effective and equitable CRC screening.
Publisher: United States: Intellisphere, LLC
Language: English
Identifier: ISSN: 1088-0224
EISSN: 1936-2692
DOI: 10.37765/ajmc.2023.89402
PMID: 37523455
Source: GFMER Free Medical Journals
MEDLINE

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A "sludge audit" for health system colorectal cancer screening services

COPYRIGHT 2023 Intellisphere, LLC ;Copyright MultiMedia Healthcare Inc. 2023 ;ISSN: 1088-0224 ;EISSN: 1936-2692 ;DOI: 10.37765/ajmc.2023.89402 ;PMID: 37523455

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