Using active choice to increase cancer screening


High-value cancer screening tests including colonoscopy and mammography are effective for early identification of cancer. However, many eligible patients do not receive these tests. The electronic health record (EHR) has grown in adoption and could be leveraged to change clinician and patient behavior.


We evaluated an active choice intervention in the EHR that prompted physicians and their medical assistants to decide whether or not to order colonoscopy and mammography for patients visiting their physician at an internal medicine clinic. 


Compared to similar control practices, this intervention led to a 35% to 40% relative increase in colonoscopy and mammography orders.  


Based on these findings, the health system decided to expand the approach to other primary care clinics in the Penn Medicine network. Upon expansion, the active choice intervention was refined from previously being delivered to physicians and their medical assistants to being delivered only to medical assistants who template orders for physicians to review and sign. 


Leonard Davis Institute of Health Economics (LDI)

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