HealthPartners, Essentia Health study to look at increasing preventive cancer care in rural areas

MINNEAPOLIS, Minn. – A HealthPartners Institute study will assess whether a clinical decision support tool in electronic medical records called the Cancer Prevention Wizard can increase preventive care in rural areas for cancer.

The Cancer Prevention Wizard (CP Wizard) helps primary care providers identify all eligible patients ages 11-80 who are not up-to-date on recommended cancer prevention services and it provides them with evidence-based recommendations for primary and secondary cancer prevention. Primary cancer prevention will include smoking cessation, body weight management, and human papilloma virus (HPV) vaccination. Secondary cancer prevention will include screening tests for colorectal, breast, cervical and lung cancer according to US Preventive Services Task Force guidelines.

The 5-year study, Implementing Cancer Prevention Using Patient-Provider Clinical Decision Support, will involve more than 150,000 patients who receive care at 30 Essentia Health primary care clinics in northern Minnesota, northwestern Wisconsin and eastern North Dakota. Using a cluster-randomized trial design, the study will compare three groups of clinics: in one group, primary care providers will use the tool to identify and offer prevention services to their patients; in a second group, certified medical assistants will use the tool and discuss screening and prevention options with patients before they see their doctor. The third group includes clinics where patients will get usual care that has no cancer prevention activities promoted by the CP Wizard. In addition, the CP Wizard will personalize recommendations by determining each patient’s unique characteristics and using special cancer risk assessment tools from the National Cancer Institute.

Researchers will assess whether use of the CP Wizard results in more patients getting recommended primary and secondary cancer preventive services and whether certified medical assistants have an effect on patient outcomes. The study will also evaluate if use of the Cancer Prevention Wizard results in higher short-term health care costs but lower long-term costs compared to clinics that do not use the tool.

“Nearly one in four Americans live in rural areas, and this study has the potential to improve their health and quality of life because research clearly shows that in general people in rural areas have higher rates of chronic illnesses than people who live in larger cities,” said Tom Elliott, MD, HealthPartners Institute senior research fellow and principal investigator.

“This tool will create a patient’s risk profile for cancer and display it in one place so that the clinician and the patient can engage in a shared decision making discussion to create a plan for primary prevention of cancer and cancer screening. The rapid collection of the data creates efficiency for a busy clinician and how it displays this data for the patient will lead to better patient engagement,” said Joe Bianco, MD, Essentia Health co-investigator on the study.

This research is supported by a $3 million grant from the National Cancer Institute of the National Institutes of Health under Award Number R01 CA193396. It is the third partnership between HealthPartners and Essentia Health to use clinical decision support tools in electronic medical records to provide evidence-based guidelines in the exam room to improve care. Other decision support tools being studied include providing current recommendations to reduce cardiovascular risk in patients with serious mental illness and identifying patients that have pre-diabetes who are at risk of developing diabetes if left untreated. According to the Agency for Healthcare Research and Quality rural residents have fewer visits to health care providers and are less likely to receive recommended preventive services including cancer prevention and management of cardiovascular disease and diabetes.