Background Colorectal cancer (CRC) screening is effective but underused. Guidelines for which tests are recommended and at what intervals depend on specific risks. We developed a tablet-based Cancer Risk Intake System (CRIS) that asks questions about risk prior to appointments and generates tailored printouts for patients and physicians summarizing and matching risk factors with guideline-based recommendations. Methods Randomized controlled trial among patients who: (1) used CRIS and they and their physicians received tailored printouts; (2) used CRIS to answer questions but received standard information about cancer screening while their physicians received a standard electronic chart prompt indicating they were age-eligible but not currently adherent for CRC screening; or (3) comprised a no-contact group that neither used CRIS nor received any information while their physicians received the standard prompt. Participation in testing was assessed via electronic medical record at 12 months. Results Participation in any CRC testing was three times higher for those who used the CRIS and received any printed materials, compared to no-contact controls (47% v. 16%; p < 0.0001). Among CRIS users ages 50 and older, participation in any testing was higher in the tailored group (53% v. 44%, p=0.023). Conclusion Use of CRIS and receipt of any information facilitated participation in testing. There was more testing participation in the CRIS-tailored than nontailored group. Impact Asking patients questions about their specific risk factors and giving them and their providers’ information just prior to an appointment may increase participation in CRC testing. Tailoring the information has some added benefit.
Assess whether receipt of tailored printouts generated by the Cancer Risk Intake System (CRIS) – a touch-screen computer program that collects data from patients and generates printouts for patients and physicians – results in more reported patient-provider discussions about colorectal cancer (CRC) risk and screening than receipt of non-tailored information.Cluster-randomized trial, randomized by physician, with data collected via CRIS prior to visit and 2-week follow-up telephone survey among 623 patients.Patients aged 25–75 with upcoming primary-care visits and eligible for, but currently non-adherent to CRC screening guidelines.Patient-reported discussions with providers about CRC risk and testing.Tailored recipients were more likely to report patient-physician discussions about personal and familial risk, stool testing, and colonoscopy (all p < 0.05). Tailored recipients were more likely to report discussions of: chances of getting cancer (+ 10%); family history (+ 15%); stool testing (+ 9%); and colonoscopy (+ 8%) (all p < 0.05).CRIS is a promising strategy for facilitating discussions about testing in primary-care settings.
The objective of this review was to summarize the current literature of community-based colorectal cancer screening randomized controlled trials with multi-ethnic groups. The CDC reports 40% of adults do not receive time-appropriate colorectal cancer screening. Although overall screening rates have improved since 2000, disparities remain. Studies examining community characteristics may offer insight into improving screening rates and eliminating disparities. We identified community-based colorectal cancer screening studies using PubMed and Ovid Medline database searches. Inclusion criteria were: community-based, randomized controlled trials; English language; published from 1/2001 to 8/2009; all colorectal cancer screening test interventions recommended in the 2008 "Joint Consensus" report; and study participants from at least two racial/ethnic groups, with not more than 90% representation from one group. There were 29 relevant articles published during 2001-2009; with 15 meeting inclusion criteria. We categorized the final studies (n = 15) into the four categories of Patient mailings (n = 3), Telephone outreach (n = 3), Electronic/multimedia (n = 4), and Counseling/community education (n = 5). Of 15 studies, 11 (73%) demonstrated increased screening rates for the intervention group compared to controls, including all studies (100%) from the Patient mailings and Telephone outreach groups, 4 of 5 (80%) Counseling/community education studies, and 1 of 4 (25%) Electronic/multimedia interventions. Patient choice and tailoring of information were common features of trials that increased screening rates across study categories. Including community-level factors and social context may be useful in future design and evaluation of colorectal cancer interventions to reduce or prevent new cases of colorectal cancer.
Background: Adverse drug events (ADEs) result in excess hospitalizations. Thorough admission medication histories (AMHs) may prevent ADEs; however, the resources required oftentimes outweigh what is available in large hospital settings. Previous risk prediction models embedded into the Electronic Medical Record (EMR) have been used at hospitals to aid in targeting delivery of scarce resources. Objective: To determine if an AMH scoring tool used to allocate resources can decrease 30-day hospital readmissions. Design, Setting, and Participants: Propensity-matched cohort study, Medicine/Surgery patients in large academic safety-net hospital. Intervention or Exposure: Pharmacy-conducted AMHs identified by risk model versus standard of care AMH. Main Outcomes and Measures: A total of 30-day hospital readmissions and inpatient ADE prevention. Results: The model screened 87 240 hospitalizations between June 2017 and June 2019 and 4027 patients per group were included. There were significantly less 30 day readmissions among high-risk identified patients that received a pharmacy-conducted AMH compared to controls (11% vs 15%; P = 0.004) and no significant difference in readmission rates for low-risk patients. While there was significantly higher documentation of major ADE prevention in the pharmacy-led AMH group versus control (1656 vs 12; P < 0.001), there was no difference in electronically-detected inpatient ADEs between groups. Conclusions: A risk tool embedded into the EMR can be used to identify patients whom pharmacy teams can easily target for AMHs. This study showed significant reductions in readmissions for patients identified as high-risk. However, the same benefit in readmissions was not seen in those identified at low-risk, which supports allocating resources to those that will benefit the most.
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