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A system-based intervention to improve colorectal cancer screening uptake.
MedLine Citation:
PMID:  21348568     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: To determine whether mailing guaiac-based fecal occult blood tests (gFOBTs) directly to patients who are due for colorectal cancer screening would achieve higher screening uptake than using visit-based screening.
STUDY DESIGN: Comparative effectiveness analysis.
METHODS: We used an electronic medical record to identify 7053 New Mexico Veterans Affairs Health Care System patients aged 50 to 80 years who were due for screening in 2008. We invited 3869 randomly selected patients to participate in a randomized controlled trial comparing adherence with different fecal blood tests; 202 intervention patients were assigned to receive mailed gFOBTs. We identified the following 3 control groups who could receive only visit-based colorectal cancer screening: 3184 individuals who were not invited for the randomized controlled trial (control group 1), 2525 individuals who did not respond to invitations to participate in the randomized controlled trial (control group 2), and 255 individuals who could not be contacted (control group 3). We measured gFOBT screening within 3 months after enrollment in the intervention group, as well as gFOBT or colonoscopy screening within 6 months of identification as a control subject. We compared screening across groups using multivariate logistic regression analysis to adjust for sex, race/ethnicity, clinic site, previous gFOBT, and comorbidities.
RESULTS: Colorectal screening occurred less often in each of the control groups (in 18.6% of control group 1, in 14.3% of control group 2, and in 18.8% of control group 3) than among patients mailed a gFOBT (48.5%). Adjusted odds ratios for screening among the control groups were all less than in the intervention group (adjusted odds ratios, 0.25, 0.19, and 0.23, respectively; all, P <.001).
CONCLUSION: Using an electronic medical record to identify screening-eligible patients and mailing them gFOBT cards achieved higher colorectal screening uptake than performing visit-based screening.
Authors:
Richard M Hoffman; Susan R Steel; Ellen F T Yee; Larry Massie; Ronald M Schrader; Maurice L Moffett; Glen H Murata
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of managed care     Volume:  17     ISSN:  1936-2692     ISO Abbreviation:  Am J Manag Care     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-02-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9613960     Medline TA:  Am J Manag Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  49-55     Citation Subset:  H    
Affiliation:
New Mexico VA Health Care System, 1501 San Pedro Dr SE, MS 111, Albuquerque, NM 87108. E-mail: rhoffman@unm.edu.
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