Patient randomized trial of a targeted navigation program to improve rates of follow-up colonoscopy in community health centers

Coronado, Gloria D.; Johnson, Eric S.; Leo, Michael C.; Schneider, Jennifer L.; Smith, David H.; Mummadi, Raj; Petrik, Amanda F.; Thompson, Jamie H; Jiménez, Ricardo

doi:10.1016/j.cct.2019.105920

Cited by 10 publications

(9 citation statements)

References 33 publications

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“…These supports are particularly needed for patients aged 65 and older, those who lack health insurance, and those who have not attended a clinic visit in the year prior to an abnormal FIT result. Prediction modeling could be useful to further identify patients who may benefit most from such supports [ 15 ]. Moreover, our findings show that while fewer than half of patients with an abnormal FIT completed a colonoscopy, time to colonoscopy completion overall was within the timeframe of national benchmarks, possibly suggesting an absence of prolonged scheduling delays among those who successfully access care.…”

Section: Discussionmentioning

confidence: 99%

“…The PRECISE study is an individual randomized controlled trial of patient navigation versus usual care for follow-up colonoscopy completion among patients who receive an abnormal FIT result at Sea Mar Community Health Centers [ 15 ]. As part of PRECISE, we conducted a baseline assessment of follow-up colonoscopy in a retrospective cohort of patients who had an abnormal FIT result over a one-year interval from August 5, 2017, to August 4, 2018.…”

Section: Methodsmentioning

confidence: 99%

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Follow-up colonoscopy after an abnormal stool-based colorectal cancer screening result: analysis of steps in the colonoscopy completion process

et al. 2021

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Background Delays in receiving follow-up colonoscopy after an abnormal fecal immunochemical test (FIT) result are associated with increased colorectal cancer incidence and mortality. Little is known about patterns of follow-up colonoscopy completion in federally qualified health centers. Methods We abstracted the medical records of health center patients, aged 50–75 years, who had an abnormal FIT result between August 5, 2017 and August 4, 2018 (N = 711). We assessed one-year rates of colonoscopy referral, pre-procedure visit completion, colonoscopy completion, and time to colonoscopy; associations between these outcomes and patient characteristics; and reasons for non-completion found in the medical record. Results Of the 711 patients with an abnormal FIT result, 90% were referred to colonoscopy, but only 52% completed a pre-procedure visit, and 43% completed a colonoscopy within 1 year. Median time to colonoscopy was 83 days (interquartile range: 52–131 days). Pre-procedure visit and colonoscopy completion rates were relatively low in patients aged 65–75 (vs. 50–64), who were uninsured (vs. insured) or had no clinic visit in the prior year (vs. ≥ 1 clinic visit). Common reasons listed for non-completion were that the patient declined, or the provider could not reach the patient. Discussion Efforts to improve follow-up colonoscopy rates in health centers might focus on supporting the care transition from primary to specialty gastroenterology care and emphasize care for older uninsured patients and those having no recent clinic visits. Our findings can inform efforts to improve follow-up colonoscopy uptake, reduce time to colonoscopy receipt, and save lives from colorectal cancer. Trial registration: National Clinical Trial (NCT) Identifier: NCT03925883.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Follow-up colonoscopy after an abnormal stool-based colorectal cancer screening result: analysis of steps in the colonoscopy completion process

et al. 2021

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“…The study is a collaborative partnership between the Oregon Health & Science University’s Oregon Rural Practice-based Research Network and the Kaiser Permanente Northwest Center for Health Research. Study activities build on prior mailed FIT and patient navigation implementation research conducted by our team [ 32 – 44 ], best practices identified at a Centers for Disease Control Mailed FIT Summit [ 45 ], rural cancer control recommendations by rural health experts [ 46 ], participatory implementation science principles [ 47 ], and formative research conducted by the Community Health Advocacy and Research Alliance [ 31 , 48 – 50 ].…”

Section: Methodsmentioning

confidence: 99%

“…Our mailed FIT outreach program uses a collaborative clinic-health plan-vendor model designed and pilot-tested by our team as part of the BeneFIT study [ 56 ] and adapted for rural regions [ 55 , 56 ]. The patient navigation component uses the New Hampshire Colorectal Cancer Screening Program [ 61 ], with adaptations based on prior implementations by our study team and pilot-testing for rural clinics [ 44 , 62 ]. The implementation of the multi-component program is supported by workflow mapping, formal training, and ongoing implementation support provided by practice facilitators and other members of the research team.…”

Section: Methodsmentioning

confidence: 99%

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Mailed fecal testing and patient navigation versus usual care to improve rates of colorectal cancer screening and follow-up colonoscopy in rural Medicaid enrollees: a cluster-randomized controlled trial

Coronado

Leo

Ramsey

et al. 2022

Implement Sci Commun

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Background Screening reduces incidence and mortality from colorectal cancer (CRC), yet US screening rates are low, particularly among Medicaid enrollees in rural communities. We describe a two-phase project, SMARTER CRC, designed to achieve the National Cancer Institute Cancer MoonshotSM objectives by reducing the burden of CRC on the US population. Specifically, SMARTER CRC aims to test the implementation, effectiveness, and maintenance of a mailed fecal test and patient navigation program to improve rates of CRC screening, follow-up colonoscopy, and referral to care in clinics serving rural Medicaid enrollees. Methods Phase I activities in SMARTER CRC include a two-arm cluster-randomized controlled trial of a mailed fecal test and patient navigation program involving three Medicaid health plans and 30 rural primary care practices in Oregon and Idaho; the implementation of the program is supported by training and practice facilitation. Participating clinic units were randomized 1:1 into the intervention or usual care. The intervention combines (1) mailed fecal testing outreach supported by clinics, health plans, and vendors and (2) patient navigation for colonoscopy following an abnormal fecal test result. We will evaluate the effectiveness, implementation, and maintenance of the intervention and track adaptations to the intervention and to implementation strategies, using quantitative and qualitative methods. Our primary effectiveness outcome is receipt of any CRC screening within 6 months of enrollee identification. Our primary implementation outcome is health plan- and clinic-level rates of program delivery, by component (mailed FIT and patient navigation). Trial results will inform phase II activities to scale up the program through partnerships with health plans, primary care clinics, and regional and national organizations that serve rural primary care clinics; scale-up will include webinars, train-the-trainer workshops, and collaborative learning activities. Discussion This study will test the implementation, effectiveness, and scale-up of a multi-component mailed fecal testing and patient navigation program to improve CRC screening rates in rural Medicaid enrollees. Our findings may inform approaches for adapting and scaling evidence-based approaches to promote CRC screening participation in underserved populations and settings. Trial registration Registered at clinicaltrial.gov (NCT04890054) and at the NCI’s Clinical Trials Reporting Program (CTRP #: NCI-2021-01032) on May 11, 2021.

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Randomized in error in pragmatic clinical trials

Tong,

Coronado,

et al. 2025

Contemporary Clinical Trials

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Patient randomized trial of a targeted navigation program to improve rates of follow-up colonoscopy in community health centers

Cited by 10 publications

References 33 publications

Follow-up colonoscopy after an abnormal stool-based colorectal cancer screening result: analysis of steps in the colonoscopy completion process

Follow-up colonoscopy after an abnormal stool-based colorectal cancer screening result: analysis of steps in the colonoscopy completion process

Mailed fecal testing and patient navigation versus usual care to improve rates of colorectal cancer screening and follow-up colonoscopy in rural Medicaid enrollees: a cluster-randomized controlled trial

Randomized in error in pragmatic clinical trials

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