Improving Colorectal Cancer Screening and Follow-up: Results of a Multi-Organization Quality Improvement Collaborative

Colorectal cancer (CRC) screening rates in the United States remain below national targets, and follow-up after abnormal stool-based testing is frequently incomplete. This study evaluated changes in CRC screening rates, age-based screening disparities, and 90-day follow-up colonoscopy completion among health care organizations participating in a national quality improvement learning collaborative. Using a mixed-methods, pre-test post-test design, 18 health care organizations serving approximately 3.9 million patients aged 45–75 years reported quarterly aggregate data from the third quarter of 2023 through the first quarter of 2025. Up-to-date (UTD) screening rates and 90-day follow-up colonoscopy completion after abnormal non-colonoscopy results were stratified by age group (45–49, 50–64, and 65–75 years). Group averages and within-organization changes were assessed using chi-square tests and paired t- tests, and qualitative implementation data were analyzed using the Consolidated Framework for Implementation Research. The group average UTD screening rate increased from 61.3% to 66.2%, a 4.9-percentage-point improvement ( P < 0.001), corresponding to an estimated 133,538 additional patients screened. Ninety-day follow-up colonoscopy completion increased from 36.2% to 42.9% ( P = 0.005). The screening gap between patients aged 45–49 years and those aged 65–75 years narrowed from 35.7 to 26.3 percentage points ( P < 0.001). High-impact implementation strategies included readiness assessment, facilitation, data infrastructure development, coalition-building, and performance feedback. Participation in a structured national learning collaborative was associated with meaningful improvements in screening, follow-up, and equity across diverse organizations, supporting collaborative, data-driven approaches to advancing preventive care in population health management. Together, these findings constitute statistically meaningful results across the full screening continuum.