# Do no harm: the impact of implementing cancer prevention strategies on other preventive health measures

## TL;DR

This study examines how a colorectal cancer screening initiative affects other preventive health measures, finding no negative impact on other services.

## Contribution

The study introduces a framework for evaluating quality improvement initiatives by considering their impact on multiple health measures simultaneously.

## Key findings

- The CRC screening initiative increased CRC screening rates by 12.2 percentage points.
- There was no reduction in performance for six other preventive health measures during the initiative.
- The initiative did not alter the secular trends of other preventive services.

## Abstract

Translational efforts to increase uptake of evidence-based practices typically look at those outcomes in isolation of their impact on other aspects of care delivery. If we are in fact to “do no harm”, we must consider the possible negative impact of improving use of one practice on other quality measures. Alternatively, a focus on one practice could lead to spread of effective strategies to other practices, which would be highly beneficial. We studied the impact of a colorectal cancer (CRC) screening initiative on delivery of other preventive care measures.

We used an interrupted time series design with implementation year as the interruption point. The initiative was conducted between 2015 and 2020, with three staggered cohorts. Main outcomes were quality measures for colorectal cancer screening, cervical cancer screening, hypertension management, diabetes management, weight screening and follow-up, tobacco use screening and cessation treatment, and depression screening and follow-up.

The initiative was associated with an increase in CRC screening (OR = 1.67, p ≤ 0.01; average marginal effect = 12.2% points), and did not reduce performance on other quality measures in the year of CRC program implementation or a change in their respective secular trends.

The initiative led to a clinically meaningful increase in CRC screening and was not associated with reductions in delivery of six other preventive services. Quality improvement (QI) initiatives typically approach implementation with an eye towards reducing unintended impact and leveraging existing staff and resources. Implementation research studies may benefit from considering how QI initiatives factor in the local context in implementation efforts.