No abstract

PURPOSE More effective strategies are needed to improve rates of colorectal cancer screening, particularly among the poor, racial and ethnic minorities, and individuals with limited English profi ciency. We examined whether the direct mailing of fecal occult blood testing (FOBT) kits to patients overdue for such screening is an effective way to improve screening in this population. METHODSAll adults aged 50 to 80 years who did not have documentation of being up to date with colorectal cancer screening as of December 31, 2009, and who had had at least 2 visits to the community health center in the prior 18 months were randomized to the outreach intervention or usual care. Patients in the outreach group were mailed a colorectal cancer fact sheet and FOBT kit. Patients in the usual care group could be referred for screening during usual clinician visits. The primary outcome was completion of colorectal cancer screening (by FOBT, sigmoidoscopy, or colonoscopy) 4 months after initiation of the outreach protocol. Outcome measures were compared using the Fisher exact test.RESULTS Analyses were based on 104 patients assigned to the outreach intervention and 98 patients assigned to usual care. In all, 30% of patients in the outreach group completed colorectal cancer screening during the study period, compared with 5% of patients in the usual care group (P <.001). Nearly all of the screenings were by FOBT. The groups did not differ signifi cantly with respect to the percentage of patients making a clinician visit or the percentage for whom a clinician placed an order for a screening test. CONCLUSIONSThe mailing of FOBT kits directly to patients was effi cacious for promoting colorectal cancer screening among a population with high levels of poverty, limited English profi ciency, and racial and ethnic diversity. Non-visit-based outreach to patients may be an important strategy to address suboptimal rates of colorectal cancer screening among populations most at risk for not being screened. Appropriate screening and early detection can greatly reduce colorectal cancer-associated morbidity and mortality, and several national guidelines recommend regular screening for colorectal cancer among adults aged 50 years and older with high-sensitivity fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy.2-4 Nearly one-half of eligible adults are not up to date on colorectal cancer screening, however. 5Moreover, despite overall improvements in the rate of colorectal cancer screening, marked disparities persist, with lower rates of colorectal cancer screening among racial and ethnic minorities, individuals with lower income or lower educational attainment, the uninsured, and individuals Muriel Jean-Jacques, MD The direct mailing of FOBT kits to patients who are due for colorectal cancer screening has been shown to be both clinically effective 9-14 and cost-effective 15,16 for increasing colorectal cancer screening rates. The vast majority of studies assessing the effi cacy of this strategy have not included sizable...

Incorporating students longitudinally into primary care clinics is highly rated by students. The ECMH model led to improved continuity, improved perceptions of the learning climate, and higher patient centeredness. Preliminary data suggest that students add value and improve patient outcomes during longitudinal clinical experiences.

Background and Objectives: Residents as teachers (RAT) and medical students as teachers (MSAT) programs are important for the development of future physicians. In 2010, Northwestern University Feinberg School of Medicine (NUFSM) aligned RAT and MSAT programs, which created experiential learning opportunities in teaching and feedback across the graduate and undergraduate medical education continuum. The purpose of this study was to provide a curricular overview of the aligned program and to evaluate early outcomes through analysis of narrative feedback quality and participant satisfaction. Methods: Program evaluation occurred through analysis of written feedback quality provided within the aligned program and postparticipation satisfaction surveys. A total of 445 resident feedback narratives were collected from 2013 to 2016. We developed a quality coding scheme using an operational definition of feedback. After independent coding of feedback quality, an expert panel established coding consensus. We evaluated program satisfaction and perceived importance through posttraining surveys in residents and fourth-year medical students (M4s). Results: Seventy-nine residents participated in the aligned program and provided high-quality feedback with a relative quality rating of 2.71 (scale 0-3). Consistently high-quality written feedback was provided over the duration of the program and regardless of years of resident participation. Posttraining surveys demonstrated high levels of satisfaction and perceived importance of the program to both residents and M4s. Conclusions: The aligned RAT and MSAT program across the medical education continuum provided experiential learning opportunities for future physician educators with evidence of high-quality written feedback to learners and program satisfaction.