Document Detail


An automated intervention with stepped increases in support to increase uptake of colorectal cancer screening: a randomized trial.
MedLine Citation:
PMID:  23460053     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Screening decreases colorectal cancer (CRC) incidence and mortality, yet almost half of age-eligible patients are not screened at recommended intervals.
OBJECTIVE: To determine whether interventions using electronic health records (EHRs), automated mailings, and stepped increases in support improve CRC screening adherence over 2 years.
DESIGN: 4-group, parallel-design, randomized, controlled comparative effectiveness trial with concealed allocation and blinded outcome assessments. (ClinicalTrials.gov: NCT00697047)
SETTING: 21 primary care medical centers.
PATIENTS: 4675 adults aged 50 to 73 years not current for CRC screening.
INTERVENTION: Usual care, EHR-linked mailings ("automated"), automated plus telephone assistance ("assisted"), or automated and assisted plus nurse navigation to testing completion or refusal ("navigated"). Interventions were repeated in year 2.
MEASUREMENTS: The proportion of participants current for screening in both years, defined as colonoscopy or sigmoidoscopy (year 1) or fecal occult blood testing (FOBT) in year 1 and FOBT, colonoscopy, or sigmoidoscopy (year 2).
RESULTS: Compared with those in the usual care group, participants in the intervention groups were more likely to be current for CRC screening for both years with significant increases by intensity (usual care, 26.3% [95% CI, 23.4% to 29.2%]; automated, 50.8% [CI, 47.3% to 54.4%]; assisted, 57.5% [CI, 54.5% to 60.6%]; and navigated, 64.7% [CI, 62.5% to 67.0%]; P < 0.001 for all pair-wise comparisons). Increases in screening were primarily due to increased uptake of FOBT being completed in both years (usual care, 3.9% [CI, 2.8% to 5.1%]; automated, 27.5% [CI, 24.9% to 30.0%]; assisted, 30.5% [CI, 27.9% to 33.2%]; and navigated, 35.8% [CI, 33.1% to 38.6%]).
LIMITATION: Participants were required to provide verbal consent and were more likely to be white and to participate in other types of cancer screening, limiting generalizability.
CONCLUSION: Compared with usual care, a centralized, EHR-linked, mailed CRC screening program led to twice as many persons being current for screening over 2 years. Assisted and navigated interventions led to smaller but significant stepped increases compared with the automated intervention only. The rapid growth of EHRs provides opportunities for spreading this model broadly.
Authors:
Beverly B Green; Ching-Yun Wang; Melissa L Anderson; Jessica Chubak; Richard T Meenan; Sally W Vernon; Sharon Fuller
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Annals of internal medicine     Volume:  158     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-05     Completed Date:  2013-05-06     Revised Date:  2014-03-25    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  301-11     Citation Subset:  AIM; IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00697047
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MeSH Terms
Descriptor/Qualifier:
Aged
Colonoscopy
Colorectal Neoplasms / diagnosis*,  prevention & control
Comparative Effectiveness Research
Costs and Cost Analysis
Early Detection of Cancer* / methods
Electronic Health Records
Female
Humans
Male
Mass Screening* / methods
Middle Aged
Occult Blood
Patient Compliance*
Postal Service
Reminder Systems* / economics
Sigmoidoscopy
Telephone
Grant Support
ID/Acronym/Agency:
R01 CA121125/CA/NCI NIH HHS; R01CA121125/CA/NCI NIH HHS
Comments/Corrections
Comment In:
Ann Intern Med. 2013 Jun 18;158(12):JC8   [PMID:  23778932 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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