Multilevel Follow-up of Cancer Screening (mFOCUS): Protocol for a multilevel intervention to improve the follow-up of abnormal cancer screening test results

Haas, Jennifer S.; Atlas, Steven J.; Wright, Adam; Orav, E. John; Aman, David G.; Breslau, Erica S.; Burdick, Timothy E.; Carpenter, Emily; Chang, Frank Y.; Dang, Tin H.; Diamond, Courtney J.; Feldman, Sarah; Harris, K. A.; Hort, Shoshana; Housman, Molly L.; Mecker, Amrita; Lehman, Constance D.; Percac‐Lima, Sanja; Smith, R. W.; Wint, Amy J.; Yang, Jie; Zhou, Li

doi:10.1016/j.cct.2021.106533

Cited by 4 publications

(10 citation statements)

References 21 publications

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“…Details of the study have been published . The trial protocol appears in Supplement 1 and the eMethods appear in Supplement 2.…”

Section: Methodsmentioning

confidence: 99%

“…Patients in the EHR reminders, outreach, and navigation group remaining overdue after an additional 4 weeks received a follow-up call by a patient navigator that assessed social barriers to care across 9 domains: housing insecurity, food insecurity, paying for basic utilities, family caregiving, legal, transportation, financial compensation for treatment, education, and employment. Navigators used an online network of verified social service programs to help connect patients with services available in their community …”

Section: Methodsmentioning

confidence: 99%

“…Details of the study have been published. 25 The trial protocol appears in Supplement 1 and the eMethods appear in Supplement 2. Briefly, we designed a pragmatic, cluster randomized clinical trial involving 44 primary care practices within 3 primary care networks: Brigham and Women's Hospital (15 practices), Dartmouth Health (12 practices), and Massachusetts General Hospital (17 practices).…”

Section: Study Design and Participantsmentioning

confidence: 99%

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A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results

Atlas,

Tosteson,

Wright

et al. 2023

JAMA

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ImportanceRealizing the benefits of cancer screening requires testing of eligible individuals and processes to ensure follow-up of abnormal results.ObjectiveTo test interventions to improve timely follow-up of overdue abnormal breast, cervical, colorectal, and lung cancer screening results.Design, Setting, and ParticipantsPragmatic, cluster randomized clinical trial conducted at 44 primary care practices within 3 health networks in the US enrolling patients with at least 1 abnormal cancer screening test result not yet followed up between August 24, 2020, and December 13, 2021.InterventionAutomated algorithms developed using data from electronic health records (EHRs) recommended follow-up actions and times for abnormal screening results. Primary care practices were randomized in a 1:1:1:1 ratio to (1) usual care, (2) EHR reminders, (3) EHR reminders and outreach (a patient letter was sent at week 2 and a phone call at week 4), or (4) EHR reminders, outreach, and navigation (a patient letter was sent at week 2 and a navigator outreach phone call at week 4). Patients, physicians, and practices were unblinded to treatment assignment.Main Outcomes and MeasuresThe primary outcome was completion of recommended follow-up within 120 days of study enrollment. The secondary outcomes included completion of recommended follow-up within 240 days of enrollment and completion of recommended follow-up within 120 days and 240 days for specific cancer types and levels of risk.ResultsAmong 11 980 patients (median age, 60 years [IQR, 52-69 years]; 64.8% were women; 83.3% were White; and 15.4% were insured through Medicaid) with an abnormal cancer screening test result for colorectal cancer (8245 patients [69%]), cervical cancer (2596 patients [22%]), breast cancer (1005 patients [8%]), or lung cancer (134 patients [1%]) and abnormal test results categorized as low risk (6082 patients [51%]), medium risk (3712 patients [31%]), or high risk (2186 patients [18%]), the adjusted proportion who completed recommended follow-up within 120 days was 31.4% in the EHR reminders, outreach, and navigation group (n = 3455), 31.0% in the EHR reminders and outreach group (n = 2569), 22.7% in the EHR reminders group (n = 3254), and 22.9% in the usual care group (n = 2702) (adjusted absolute difference for comparison of EHR reminders, outreach, and navigation group vs usual care, 8.5% [95% CI, 4.8%-12.0%], P &lt; .001). The secondary outcomes showed similar results for completion of recommended follow-up within 240 days and by subgroups for cancer type and level of risk for the abnormal screening result.Conclusions and RelevanceA multilevel primary care intervention that included EHR reminders and patient outreach with or without patient navigation improved timely follow-up of overdue abnormal cancer screening test results for breast, cervical, colorectal, and lung cancer.Trial RegistrationClinicalTrials.gov Identifier: NCT03979495

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“…Details of the study have been published . The trial protocol appears in Supplement 1 and the eMethods appear in Supplement 2.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Study Design and Participantsmentioning

confidence: 99%

See 1 more Smart Citation

A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results

Atlas,

Tosteson,

Wright

et al. 2023

JAMA

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show abstract

“…This study was conducted as part of a National Cancer Institute–funded trial, mFOCUS (multilevel Follow-up of Cancer Screening) . The trial was designed from the perspective of PCPs who take a whole-person approach with responsibility for all cancer screening tests endorsed by the US Preventive Services Task Force .…”

Section: Methodsmentioning

confidence: 99%

“…This study was conducted as part of a National Cancer Institute-funded trial, mFOCUS (multilevel Follow-up of Cancer Screening). 19 The trial was designed from the perspective of PCPs who take a whole-person approach with responsibility for all cancer screening tests endorsed by the US Preventive Services Task Force. 1,2,4,5 Although the PCP may not order or perform a screening test and there are systems and policies designed to focus on a single type of cancer (eg, the Mammography Quality Standards Act for breast cancer screening results), PCPs are responsible for comprehensive cancer screening in collaboration with specialists or other clinicians involved in the diagnostic evaluation of abnormal screens.…”

Section: Overviewmentioning

confidence: 99%

Primary Care Practitioner Perceptions on the Follow-up of Abnormal Cancer Screening Test Results

et al. 2022

Self Cite

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ImportanceHealth care systems focus on delivering routine cancer screening to eligible individuals, yet little is known about the perceptions of primary care practitioners (PCPs) about barriers to timely follow-up of abnormal results.ObjectiveTo describe PCP perceptions about factors associated with the follow-up of abnormal breast, cervical, colorectal, and lung cancer screening test results.Design, Setting, and ParticipantsSurvey study of PCPs from 3 primary care practice networks in New England between February and October 2020, prior to participating in a randomized clinical trial to improve follow-up of abnormal cancer screening test results. Participants were physicians and advanced practice clinicians from participating practices.Main Outcomes and MeasuresSelf-reported process, attitudes, knowledge, and satisfaction about the follow-up of abnormal cancer screening test results.ResultsOverall, 275 (56.7%) PCPs completed the survey (range by site, 34.9%-71.9%) with more female PCPs (61.8% [170 of 275]) and general internists (73.1% [201 of 275]); overall, 28,7% (79 of 275) were aged 40 to 49 years. Most PCPs felt responsible for managing abnormal cancer screening test results with the specific cancer type being the best factor (range, 63.6% [175 of 275] for breast to 81.1% [223 of 275] for lung; P &lt; .001). The PCPs reported limited support for following up on overdue abnormal cancer screening test results. Standard processes such as automated reports, reminder letters, or outreach workers were infrequently reported. Major barriers to follow-up of abnormal cancer screening test results across all cancer types included limited electronic health record tools (range, 28.5% [75 of 263]-36.5%[96 of 263]), whereas 50% of PCPs felt that there were major social barriers to receiving care for abnormal cancer screening test results for colorectal cancer. Fewer than half reported being very satisfied with the process of managing abnormal cancer screening test results, with satisfaction being greatest for breast cancer (46.9% [127 of 271]) and lowest for cervical (21.8% [59 of 271]) and lung cancer (22.4% [60 of 268]).Conclusions and RelevanceIn this survey study of PCPs, important deficiencies in systems for managing abnormal cancer screening test results were reported. These findings suggest a need for comprehensive organ-agnostic systems to promote timely follow-up of abnormal cancer screening results using a primary care–focused approach across the range of cancer screening tests.

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Patient Perceptions on the Follow-Up of Abnormal Cancer Screening Test Results

Atlas,

Gallagher,

McGovern

et al. 2024

J GEN INTERN MED

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Multilevel Follow-up of Cancer Screening (mFOCUS): Protocol for a multilevel intervention to improve the follow-up of abnormal cancer screening test results

Cited by 4 publications

References 21 publications

A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results

A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results

Primary Care Practitioner Perceptions on the Follow-up of Abnormal Cancer Screening Test Results

Patient Perceptions on the Follow-Up of Abnormal Cancer Screening Test Results

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