Sundowning.

Few cancers have effective screening strategies, but there is no doubt breast and colorectal cancer screenings detect cancers at earlier, more curable stages. In this battle, primary care physicians are on the frontline, but they’re experiencing heavier workloads as more evidence-based health screenings become standard while reimbursement structures favor quantity over quality patient care. This pragmatic look at 33 primary care practices within the U Penn system assessed the proportion of patients eligible—based on age and interval since last screening—for breast (n = >19K) and/or colorectal (n = >33K) cancer screenings who received orders for such. Interestingly, if not surprisingly, rates of appropriate screening for breast cancer significantly varied per appointment time: 64% (8am) → 49% (11am) → 56% (noon) → 48% (5pm). As did screening orders for colorectal cancer: 37% (8am) → 31% (11am) → 34% (noon) → 23% (5pm). TBL: Rates of appropriate cancer screening ordered by primary care physicians during routine clinic visits appear to mirror their glucose levels. | Hsiang, JAMA 2019