Comparative Effectiveness of Fecal Immunochemical Test Outreach, Colonoscopy Outreach, and Usual Care for Boosting Colorectal Cancer Screening Among the Underserved

Gupta, Samir; Halm, Ethan A.; Rockey, Don C.; Hammons, Marcia; Koch, Mark; Carter, Elizabeth; Valdez, Luisa; Tong, Liyue; Ahn, Chul; Kashner, Michael; Argenbright, Keith; Tiro, Jasmin A.; Geng, Zhuo; Pruitt, Sandi L.; Skinner, Celette Sugg

doi:10.1001/jamainternmed.2013.9294

Cited by 183 publications

(236 citation statements)

References 32 publications

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“…This may explain why our usual care group FIT completion rate was higher than other studies. Gupta and colleagues reported a 12.1 % completion rate at 12 months in their usual care group, which included patients previously screened, 17 whereas we found a 14.8 % rate at 6 months and a 22.4 % rate at 12 months. Nevertheless, the completion rate in our usual care group was low, even among patients with two or more CHC visits (26.7 %), demonstrating the limitations of point-of-care strategies in CHCs that care for vulnerable populations.…”

Section: Discussioncontrasting

confidence: 86%

“…17 Patients randomized to FIT outreach had higher screening rates than those who received the colonoscopy letter or usual care (40.7, 24.6, and 12.1 %, respectively). Despite its importance, this study had several limitations.…”

Section: Introductionmentioning

confidence: 91%

“…13 Several randomized trials have reported that outreach with FOBT can improve CRC screening rates. [14][15][16][17][18][19][20] However, most were conducted in integrated health plans. 15 , 16 , 18 , 19 Few targeted vulnerable populations cared for in community health centers (CHCs) and other safety net settings.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

et al. 2015

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INTRODUCTION:Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care. METHODS: This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66 % were female, 62.1 % were Latino, and 70.7 % were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data. RESULTS: Patients who received outreach were more likely to complete FIT than those in usual care (36.7 % vs. 14.8 %; p<0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time. DISCUSSION: The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.KEY WORDS: health disparities; cancer prevention; care delivery system.

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Section: Discussioncontrasting

confidence: 86%

Section: Introductionmentioning

confidence: 91%

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Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

et al. 2015

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“…[4][5][6][7][8] However, CRC screening rates remain suboptimal, even after decades of public health campaigns, public reporting of health plan CRC screening rates, and implementation of visitbased preventive service reminders in electronic health records (EHRs). 4,7,[9][10][11] Therefore, a growing number of private and public health systems are taking a population health perspective and using outreach approaches to promote CRC screening that do not require a face-to-face primary care visit. 12 Active outreach strategies, such as mailed invitations for colonoscopy and/or stool blood testing, can substantially increase screening rates.…”

Section: Introductionmentioning

confidence: 99%

“…12 Active outreach strategies, such as mailed invitations for colonoscopy and/or stool blood testing, can substantially increase screening rates. [9][10][11] The extent to which primary care continues to play an important role in CRC screening in health systems with active population screening outreach programs is unknown.…”

Section: Introductionmentioning

confidence: 99%

Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach

et al. 2016

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BACKGROUND: Population outreach strategies are increasingly used to improve colorectal cancer (CRC) screening. The influence of primary care on cancer screening in this context is unknown. OBJECTIVE: To assess associations between primary care provider (PCP) visits and receipt of CRC screening and colonoscopy after a positive fecal immunochemical (FIT) or fecal occult blood test (FOBT). DESIGN: Population-based cohort study. PARTICIPANTS: A total of 968,072 patients ages 50-74 years who were not up to date with CRC screening in 2011 in four integrated healthcare systems (three with screening outreach programs using FIT kits) in the PopulationBased Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. MEASURES: Demographic, clinical, PCP visit, and CRC screening data were obtained from electronic health records and administrative databases. We examined associations between PCP visits in 2011 and receipt of FIT/ FOBT, screening colonoscopy, or flexible sigmoidoscopy (CRC screening) in 2012 and follow-up colonoscopy within 3 months of a positive FIT/FOBT in 2012. We used multivariable logistic regression and propensity score models to adjust for confounding. RESULTS: Fifty-eight percent of eligible patients completed a CRC screening test in 2012, most by FIT. Those with a greater number of PCP visits had higher rates of CRC screening at all sites. Patients with ≥1 PCP visit had nearly twice the adjusted-odds of CRC screening (OR = 1.88, 95 % CI: 1.86-1.89). Overall, 79.6 % of patients with a positive FIT/FOBT completed colonoscopy within 3 months. Patients with ≥1 PCP visit had 30 % higher adjusted odds of completing colonoscopy after positive FIT/FOBT (OR = 1.30; 95 % CI: 1.22-1.40). CONCLUSIONS:Patients with a greater number of PCP visits had higher rates of both incident CRC screening and colonoscopy after positive FIT/FOBT, even in health systems with active population health outreach programs. In this era of virtual care and population outreach, primary care visits remain an important mechanism for engaging patients in cancer screening.KEY WORDS: primary care; colorectal cancer screening; population health outreach.

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Effect of Colonoscopy Outreach vs Fecal Immunochemical Test Outreach on Colorectal Cancer Screening Completion

Singal

Gupta

Skinner

et al. 2017

JAMA

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109

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IMPORTANCE Mailed fecal immunochemical test (FIT) outreach is more effective than colonoscopy outreach for increasing 1-time colorectal cancer (CRC) screening, but long-term effectiveness may need repeat testing and timely follow-up for abnormal results.OBJECTIVE Compare the effectiveness of FIT outreach and colonoscopy outreach to increase completion of the CRC screening process (screening initiation and follow-up) within 3 years. DESIGN, SETTING, AND PARTICIPANTS Pragmatic randomized clinical trial from March 2013 to July 2016 among 5999 participants aged 50 to 64 years who were receiving primary care in Parkland Health and Hospital System and were not up to date with CRC screenings.INTERVENTIONS Random assignment to mailed FIT outreach (n = 2400), mailed colonoscopy outreach (n = 2400), or usual care with clinic-based screening (n = 1199). Outreach included processes to promote repeat annual testing for individuals in the FIT outreach group with normal results and completion of diagnostic and screening colonoscopy for those with an abnormal FIT result or assigned to colonoscopy outreach. MAIN OUTCOMES AND MEASURESPrimary outcome was screening process completion, defined as adherence to colonoscopy completion, annual testing for a normal FIT result, diagnostic colonoscopy for an abnormal FIT result, or treatment evaluation if CRC was detected. Secondary outcomes included detection of any adenoma or advanced neoplasia (including CRC) and screening-related harms (including bleeding or perforation).RESULTS All5999participants(medianage,56years;women,61.9%)wereincludedintheintentionto-screen analyses. Screening process completion was 38.4% in the colonoscopy outreach group, 28.0% in the FIT outreach group, and 10.7% in the usual care group. Compared with the usual care group, between-group differences for completion were higher for both outreach groups, and highest in the colonoscopy outreach group. Compared with usual care, the between-group differences in adenoma and advanced neoplasia detection rates were higher for both outreach groups, and highest in the colonoscopy outreach group. There were no screening-related harms in any groups. Between-Group Differences, % (95% CI) Colonoscopy Outreach vs Usual Care P Value FIT Outreach vs Usual Care P Value Colonoscopy Outreach vs FIT Outreach P Value Screening process completion 27.7 (25.1 to 30.4) <.001 17.3 (14.8 to 19.8) <.001 10.4 (7.8 to 13.1) <.001 Detection rate for adenoma 10.3 (9.5 to 12.1) <.001 1.3 (−0.1 to 2.8) .08 9.0 (7.3 to 10.7) <.001 Detection rate for advanced neoplasia 3.1 (2.0 to 4.1) <.001 0.7 (−0.2 to 1.6) .13 2.4 (1.3 to 3.3) <.001CONCLUSIONS AND RELEVANCE Among persons aged 50 to 64 years receiving primary care at a safety-net institution, mailed outreach invitations offering FIT or colonoscopy compared with usual care increased the proportion completing CRC screening process within 3 years. The rate of screening process completion was higher with colonoscopy than FIT outreach.

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Comparative Effectiveness of Fecal Immunochemical Test Outreach, Colonoscopy Outreach, and Usual Care for Boosting Colorectal Cancer Screening Among the Underserved

Cited by 183 publications

References 32 publications

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial

Association Between Primary Care Visits and Colorectal Cancer Screening Outcomes in the Era of Population Health Outreach

Effect of Colonoscopy Outreach vs Fecal Immunochemical Test Outreach on Colorectal Cancer Screening Completion

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