A centralized mailed program with stepped increases of support increases time in compliance with colorectal cancer screening guidelines over 5 years: A randomized trial

Abstract

Background Screening over many years is required to optimize reductions in colorectal cancer (CRC) mortality. However, no prior trials have tested methods for obtaining long-term adherence. Methods Systems of Support to Increase Colorectal Cancer Screening and Follow-Up (SOS) was implemented in an integrated healthcare organization in Washington State. Between 2008 and 2009, 4675 individuals aged 50–74 were randomized to receive: (Arm 1) Usual care (UC), which included clinic-based strategies to increase CRC screening, or in years 1 and 2: (Arm 2) Mailings with a call-in number for colonoscopy and mailed fecal tests; (Arm 3) Mailings plus brief telephone assistance; or (Arm 4) Mailings and assistance plus nurse navigation. Active intervention subjects (Arms 2, 3, and 4 combined) still eligible for CRC screening were randomized to stopped or continued mailings in years 3 and 5. We compared time in compliance with CRC screening over five years in persons assigned to any intervention versus usual care. Screening tests contributed time based on national guidelines for screening intervals (fecal tests annually, sigmoidoscopy 5-years, colonoscopy 10-years). Results All participants contributed data, but were censored at disenrollment, death, age 76, or CRC diagnosis. Compared to UC, intervention participants had 31% more adjusted covered-time over 5 years (Incidence Rate Ratio 1.31 [1.25–1.37], 47.5% vs. 62.1% covered-time). Fecal testing accounted for almost all additional covered-time. Conclusions In a healthcare organization with clinic-based activities to increase CRC screening, a centralized program led to increased CRC screening adherence over 5 years. Longer-term data on screening adherence and its impact on CRC outcomes are needed.

Colorectal Cancer Screening: Money Isn’t Everything . . . But It Helps!

“…10 Mailed outreach with FIT increased CRC screening rates by 31% in a randomized trial. 11 In our screening program at Kaiser Permanente Northern California, we use organized mailed FIT outreach coupled with opportunistic colonoscopy by primary care physician referral. We provide regular feedback on performance to our primary care physicians.…”

Modifiable Failures in the Colorectal Cancer Screening Process and Their Association With Risk of Death

“…In this study, about one-third of patients who died from CRC had not screened at appropriate intervals, pointing to the need for improvements in identifying those who may delay initiating screening and improving long term adherence to screening. Evidence on interventions to improve repeat screening is scant, 34 though reminders have been shown to improve adherence to fecal testing, 32 which has a more frequent testing interval (annually or biennially) than non-stool tests (sigmoidoscopy every 5 years and colonoscopy every 10 years).…”

Two Medicaid health plans’ models and motivations for improving colorectal cancer screening rates

“…Centralized CRC screening interventions have been successful in many national health care programs [13,[15][16][17] and integrated health care organizations (i.e., a single-payer system), such as Kaiser Permanente or the Veteran's Administration [40][41][42][43][44]. However, when shifting to a health care setting with multiple types of insurance, including U.S. Medicaid, outreach interventions are more complicated to implement and fund.…”