Colorectal Cancer Screening and Yield in a Mailed Outreach Program in a Safety-Net Healthcare System

Murphy, Caitlin C.; Halm, Ethan A.; Zaki, Timothy A.; Johnson, Carmen; Yekkaluri, Sruthi; Quirk, Lisa; Singal, Amit G.

doi:10.1007/s10620-021-07313-7

Cited by 10 publications

(8 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This helps unburden primary care teams who are responsible for numerous preventative health recommendations 12. MFPs have demonstrated increased screening rates across various populations including low-income and racially diverse groups, and among rural veterans 9 13–16…”

Section: Introductionmentioning

confidence: 99%

Implementation of a mailed faecal immunochemical test programme for colorectal cancer screening among Veterans

et al. 2022

View full text Add to dashboard Cite

BackgroundScreening for colorectal cancer (CRC) with faecal immunochemical test (FIT) is effective at reducing CRC mortality. Unfortunately, the COVID-19 pandemic has been associated with deferred care, especially screening for CRC.AimWe sought to develop a mailed FIT programme (MFP) to increase CRC screening and make recommendations for adoption across the Veterans Health Administration (VHA) and for other large healthcare systems.Setting2 regional VA medical centres in California and Washington state.Participants5667 average risk veterans aged 50–75 overdue or due within 90 days for CRC screening.Programme descriptionA multidisciplinary implementation team collaborated to mail an FIT kit to eligible veterans. Both sites mailed a primer postcard, and one site added an automated reminder call.Programme evaluationWe monitored FIT return and positivity rate, as well as impact of the programme on clinical staff. 34% of FIT kits were returned within 90 days and 7.8% were abnormal.DiscussionWe successfully implemented a population-based MFP at multiple regional VA sites and recommend that these efforts be spread across VA. Our model of regional leadership, facility champions and using centralised resources can be adaptable to other large healthcare systems. MFPs support catch-up from disrupted care by addressing access to CRC screening, unburden primary care visits and conserve limited procedural resources.

show abstract

Section: Introductionmentioning

confidence: 99%

Implementation of a mailed faecal immunochemical test programme for colorectal cancer screening among Veterans

et al. 2022

View full text Add to dashboard Cite

show abstract

“…FIT requires no bowel preparation and can be completed at home; up-front costs are less than those of direct visualization tests; 11 and mailed outreach increases CRC screening participation by a median of 21.5% (IQR=13.6%–29.0%). 12 , 13 , 14 , 15 Therefore, increasing implementation of mailed FIT outreach has the potential to engage populations that might not otherwise seek care and address persistent disparities in CRC outcomes. 11 , 16 …”

Section: Introductionmentioning

confidence: 99%

“…To overcome these challenges and prepare for future disruptions, our healthcare system sought to increase the use of mailed FIT outreach through an organized CRC screening program and to increase screening participation equitably. Despite literature on the impact of mailed FIT programs 12 , 13 , 14 , 15 and emerging guidance documents, 15 , 17 published real-world experiences that detail the process of implementing mailed FIT as part of organized CRC screening programs are sparse. 20 , 21 In this study, we describe the process of implementing an organized CRC screening program that uses mailed FIT outreach in a large integrated healthcare system informed by the IARC and EPIS frameworks.…”

Section: Introductionmentioning

confidence: 99%

Implementing an Organized Colorectal Cancer Screening Program: Lessons Learned From an Academic–Community Practice

Kimura,

Bell-Brown,

Akinsoto

et al. 2024

AJPM Focus

View full text Add to dashboard Cite

“…This approach mitigates barriers to CRC screening that many patients face related to transportation to the clinic, limited clinic hours, and need for child or elder care and addresses many patients’ desire for a less-invasive screening test (Gupta et al, 2013 ; Lee et al, 2021 ; Mehta et al, 2016 ). Implementing mailed fecal testing has resulted in increased screening rates across multiple safety-net clinic settings (Joseph, 2016 ; Lee et al, 2021 ; Murphy et al, 2021 ; Singal et al, 2016 ). Although much evidence supports the use of mailed fecal testing as an effective approach for bolstering screening rates among disproportionately affected populations (Joseph, 2016 ; Mehta et al, 2016 ; Murphy et al, 2021 ; Singal et al, 2016 ), it remains underutilized in practice (Issaka et al, 2019 ; Wang et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“…Implementing mailed fecal testing has resulted in increased screening rates across multiple safety-net clinic settings (Joseph, 2016 ; Lee et al, 2021 ; Murphy et al, 2021 ; Singal et al, 2016 ). Although much evidence supports the use of mailed fecal testing as an effective approach for bolstering screening rates among disproportionately affected populations (Joseph, 2016 ; Mehta et al, 2016 ; Murphy et al, 2021 ; Singal et al, 2016 ), it remains underutilized in practice (Issaka et al, 2019 ; Wang et al, 2021 ). When combined with EBIs supported by CRCCP, mailed fecal testing may have even greater potential to increase screening and reduce disparities in CRC incidence and mortality (Davis et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Implementing Mailed Colorectal Cancer Fecal Screening Tests in Real-World Primary Care Settings: Promising Implementation Practices and Opportunities for Improvement

et al. 2023

View full text Add to dashboard Cite

Colorectal cancer (CRC) screening reduces morbidity and mortality, but screening rates in the USA remain suboptimal. The Colorectal Cancer Control Program (CRCCP) was established in 2009 to increase screening among groups disproportionately affected. The CRCCP utilizes implementation science to support health system change as a strategy to reduce disparities in CRC screening by directing resources to primary care clinics to implement evidence-based interventions (EBIs) proven to increase CRC screening. As COVID-19 continues to impede in-person healthcare visits and compel the unpredictable redirection of clinic priorities, understanding clinics’ adoption and implementation of EBIs into routine care is crucial. Mailed fecal testing is an evidence-based screening approach that offers an alternative to in-person screening tests and represents a promising approach to reduce CRC screening disparities. However, little is known about how mailed fecal testing is implemented in real-world settings. In this retrospective, cross-sectional analysis, we assessed practices around mailed fecal testing implementation in 185 clinics across 62 US health systems. We sought to (1) determine whether clinics that do and do not implement mailed fecal testing differ with respect to characteristics (e.g., type, location, and proportion of uninsured patients) and (2) identify implementation practices among clinics that offer mailed fecal testing. Our findings revealed that over half (58%) of clinics implemented mailed fecal testing. These clinics were more likely to have a CRC screening policy than clinics that did not implement mailed fecal testing (p = 0.007) and to serve a larger patient population (p = 0.004), but less likely to have a large proportion of uninsured patients (p = 0.01). Clinics that implemented mailed fecal testing offered it in combination with EBIs, including patient reminders (92%), provider reminders (94%), and other activities to reduce structural barriers (95%). However, fewer clinics reported having the leadership support (58%) or funding stability (29%) to sustain mailed fecal testing. Mailed fecal testing was widely implemented alongside other EBIs in primary care clinics participating in the CRCCP, but multiple opportunities for enhancing its implementation exist. These include increasing the proportion of community health centers/federally qualified health centers offering mailed screening; increasing the proportion that provide pre-paid return mail supplies with the screening kit; increasing the proportion of clinics monitoring both screening kit distribution and return; ensuring patients with abnormal tests can obtain colonoscopy; and increasing sustainability planning and support.

show abstract

Colorectal Cancer Screening and Yield in a Mailed Outreach Program in a Safety-Net Healthcare System

Cited by 10 publications

References 55 publications

Implementation of a mailed faecal immunochemical test programme for colorectal cancer screening among Veterans

Implementation of a mailed faecal immunochemical test programme for colorectal cancer screening among Veterans

Implementing an Organized Colorectal Cancer Screening Program: Lessons Learned From an Academic–Community Practice

Implementing Mailed Colorectal Cancer Fecal Screening Tests in Real-World Primary Care Settings: Promising Implementation Practices and Opportunities for Improvement

Contact Info

Product

Resources

About