Expanding use of active choice to increase cancer screening rates


In prior work, we demonstrated that an active choice intervention in the electronic health record (EHR) significantly increased ordering rates of colonoscopy and mammography. Based on this evidence, the health system decided to expand the approach to other primary care clinics.


The active choice intervention was refined from previously being delivered to physicians and their medical assistants to now being delivered only to medical assistants who could template orders for physicians to review and sign.


Compared to control practices, the intervention practice had a significant increase in ordering a colonoscopy (11.8 percentage-points; P<.001) and mammography (12.4 percentage-points; P<.001). Completion of cancer screening significantly increased at intervention practices compared to control practices for colonoscopy (3.5 percentage-points; P<.01) but not mammography (2.2 percentage points; P<0.18). These results were used to inform the design of a similar intervention that was adopted by all primary care practices at Penn Medicine.