Establish Linkages and Coordinate Care With Specialists

Linkages and active coordination of care between the office practice, specialists, and other providers is essential to providing optimal CRC screening. Sharing of information between various providers is critical to preventing under or over testing and conflicting advice.


Key Points for Implementing an Office Practice Patient Follow-up Process

  • Find specialists who will treat your patients and support your improvement efforts
  • Work with gastroenterologists, colorectal surgeons, radiologists, and/or oncologists to define appropriate patients for referral, based on established guidelines
  • Work with all specialists to clarify the approach to follow-up (i.e., the process for getting information to the primary care provider after the specialist sees the patient and content of information including pathology of biopsy specimens, recommended follow-up, and reasons for follow-up that differs from established guidelines)
  • Develop a mechanism to track the following:
    • Referral made
    • Seen by specialist
    • Specialist's letter received by primary care provider
    • Patient returns to primary care provider
  • Streamline the communication process (e.g., fax-back forms, E-mail, telephone conferences). The easier it is, the more likely it will happen
  • Give the patient a referral form that includes office contact information to take to the specialist appointment
  • Use the same specialist(s) whenever possible
  • Designate specific office personnel to do the tracking and develop a standardized process to track