Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System

Mehta, Shivan J.; Jensen, Christopher D.; Quinn, Virginia P.; Schottinger, Joanne E.; Zauber, Ann G.; Meester, Reinier G. S.; Laiyemo, Adeyinka O.; Fedewa, Stacey A.; Goodman, Michael; Fletcher, Robert H.; Levin, Theodore R.; Corley, Douglas A.; Doubeni, Chyke A.

doi:10.1007/s11606-016-3792-1

Cited by 56 publications

(68 citation statements)

References 44 publications

(44 reference statements)

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“…In general, FIT screening was associated with a lower number of procedures subject to coinsurance. If FIT screening becomes more popular in the United States similar to trends observed in several settings (37, 38), the costs of waiving the coinsurance will be even lower.…”

Section: Discussionmentioning

confidence: 90%

Value Of Waiving Coinsurance For Colorectal Cancer Screening In Medicare Beneficiaries

et al. 2017

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Out-of-pocket cost is an important barrier for utilization of health services and a contributor to health disparities. Medicare beneficiaries may face 20% coinsurance for screening colonoscopy with polyp removal or follow-up colonoscopy after a positive screening fecal test. Using an established microsimulation model, we predicted that waiving this coinsurance would result in 1.7 (-13 percent) fewer colorectal cancer deaths and US $17,000 (+0.6 percent ) higher colorectal cancer-related CMS costs per 1000 65-year-olds, when assuming an increase in colonoscopy screening rate from 60 to 70 percent. Waiving coinsurance would increase total cost by US $51,000 (+1.9 percent) per 1000 65-year-olds if screening participation were unchanged. The estimated screening benefits were comparable if fecal testing were the primary modality. Threshold analyses suggested that waiving coinsurance would already be cost-effective if screening rate increased from 60% to 60.6% (US $50,000 willingness-to-pay threshold), reflecting a likely favorable balance of health and cost impact.

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Section: Discussionmentioning

confidence: 90%

Value Of Waiving Coinsurance For Colorectal Cancer Screening In Medicare Beneficiaries

et al. 2017

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“…When necessary, we contacted study authors to specify screening versus symptomatic patients and the absolute numbers of participants who had colonoscopy. One study was excluded because it included symptomatic patients (28), and another because the intervention was unclear without additional information (29). One author provided additional results not available in the report (30); 4 authors of included studies either did not respond or no longer had access to the study data set (31–35).…”

Section: Methodsmentioning

confidence: 99%

Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests

et al. 2017

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Background: Fecal immunochemical testing is the most commonly used method for colorectal cancer screening worldwide. However, its effectiveness is frequently undermined by failure to obtain follow-up colonoscopy after positive test results. Purpose: To evaluate interventions to improve rates of follow-up colonoscopy for adults after a positive result on a fecal test (guaiac or immunochemical). Data Sources: English-language studies from the Cochrane Central Register of Controlled Trials, PubMed, and Embase from database inception through June 2017. Study Selection: Randomized and nonrandomized studies reporting an intervention for colonoscopy follow-up of asymptomatic adults with positive fecal test results. Data Extraction: Two reviewers independently extracted data and ranked study quality; 3 rated overall strength of evidence for each category of study type. Data Synthesis: Twenty-three studies were eligible for analysis, including 7 randomized and 16 nonrandomized studies. Three were at low risk of bias. Eleven studies described patient-level interventions (changes to invitation, provision of results or follow-up appointments, and patient navigators), 5 provider-level interventions (reminders or performance data), and 7 system-level interventions (automated referral, precolonoscopy telephone calls, patient registries, and quality improvement efforts). Moderate evidence supported patient navigators and provider reminders or performance data. Evidence for system-level interventions was low. Seventeen studies reported the proportion of test-positive patients who completed colonoscopy compared with a control population, with absolute differences of −7.4 percentage points (95% CI, −19 to 4.3 percentage points) to 25 percentage points (CI, 14 to 35 percentage points). Limitation: More than half of studies were at high or very high risk of bias; heterogeneous study designs and characteristics precluded meta-analysis. Conclusion: Patient navigators and the provision to providers of reminders or performance data may help improve colonoscopy rates of asymptomatic adults with positive fecal blood test results. Current evidence about useful system-level interventions is scant and insufficient.

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“…Despite rapid CRC screening uptake throughout the program, recent studies of the program reported lower odds of CRC screening in blacks and Hispanics relative to whites, calling for increased understanding of these differences. 16,17 Thus, the objective of the present study was to examine time to receipt of CRC screening from age 50 years in a program with uniform population health approaches to delivery of screening according to race/ethnicity. Detailed patterns of the type of test utilized to better understand potential racial differences in CRC screening within the organized screening program were also examined.…”

Section: Introductionmentioning

confidence: 99%

Colorectal Cancer Screening Initiation After Age 50 Years in an Organized Program

Fedewa

Corley

Jensen

et al. 2017

American Journal of Preventive Medicine

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Introduction Recent studies report racial disparities among individuals in organized colorectal cancer (CRC) programs; however, there is a paucity of information on CRC screening utilization by race/ethnicity among newly age-eligible adults in such programs. Methods This was a retrospective cohort study among Kaiser Permanente Northern California enrollees who turned age 50 years between 2007 and 2012 (N=138,799) and were served by a systemwide outreach and facilitated in-reach screening program based primarily on mailed fecal immunochemical tests to screening-eligible people. Kaplan-Meier and Cox model analyses were used to estimate differences in receipt of CRC screening in 2015–2016. Results Cumulative probabilities of CRC screening within 1 and 2 years of subjects’ 50th birthday were 51% and 73%, respectively. Relative to non-Hispanic whites, the likelihood of completing any CRC screening was similar in blacks (hazard ratio, 0.98; 95% CI=0.96, 1.00), 5% lower in Hispanics (hazard ratio, 0.95; 95% CI=0.93, 0.96), and 13% higher in Asians (hazard ratio, 1.13; 95% CI=1.11, 1.15) in adjusted analyses. Fecal immunochemical testing was the most common screening modality, representing 86% of all screening initiations. Blacks and Hispanics had lower receipt of fecal immunochemical testing in adjusted analyses. Conclusions CRC screening uptake was high among newly screening-eligible adults in an organized CRC screening program, but Hispanics were less likely to initiate screening near age 50 years than non-Hispanic whites, suggesting that cultural and other individual-level barriers not addressed within the program likely contribute. Future studies examining the influences of culturally appropriate and targeted efforts for screening initiation are needed.

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Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System

Cited by 56 publications

References 44 publications

Value Of Waiving Coinsurance For Colorectal Cancer Screening In Medicare Beneficiaries

Value Of Waiving Coinsurance For Colorectal Cancer Screening In Medicare Beneficiaries

Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests

Colorectal Cancer Screening Initiation After Age 50 Years in an Organized Program

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