Colorectal cancer screening interventions in 2 health care systems serving disadvantaged populations: Screening uptake and cost‐effectiveness

Abstract

BACKGROUND: The objectives of the current study were to assess changes in colorectal cancer (CRC) screening uptake and the cost-effectiveness of implementing multiple evidence-based interventions (EBIs). EBIs were implemented at 2 federally qualified health centers that participated in the Colorado Department of Public Health and Environment’s Clinic Quality Improvement for Population Health initiative. METHODS: Interventions included patient and provider reminder systems (health system 1), provider assessment and feedback (health systems 1 and 2), and numerous support activities (health systems 1 and 2). The authors evaluated health system 1 from July 2013 to June 2015 and health system 2 from July 2014 to June 2017. Evaluation measures included annual CRC screening uptake, EBIs implemented, funds received and expended by each health system to implement EBIs, and intervention costs to the Colorado Department of Public Health and Environment and health systems. RESULTS: CRC screening uptake increased by 18 percentage points in health system 1 and 10 percentage points in health system 2. The improvements in CRC screening uptake, not including the cost of the screening tests, were obtained at an added cost ranging from $24 to $29 per person screened. CONCLUSIONS: In both health systems, the multicomponent interventions implemented likely resulted in improvements in CRC screening. The results suggest that significant increases in CRC screening uptake can be achieved in federally qualified health centers when appropriate technical support and health system commitment are present. The cost estimates of the multicomponent interventions suggest that these interventions and support activities can be implemented in a cost-effective manner.

A conceptual framework and metrics for evaluating multicomponent interventions to increase colorectal cancer screening within an organized screening program

“… To evaluate another intervention on patient navigation, we determined the proportion of individuals who successfully received patient navigation and used a historic cohort to quantify its effectiveness . Although, in several instances, we identified adequate control cohorts to perform comparative assessments, including the use of randomization, for some of the evaluations, the study design only allowed for pre‐post assessments . In these instances, we report not only screening rates but also process measures to ensure that we capture the underlying activities and procedures that were affected by the interventions so lessons learned can be shared.…”

“…19 Although, in several instances, we identified adequate control cohorts to perform comparative assessments, including the use of randomization, for some of the evaluations, the study design only allowed for pre-post assessments. 20,21 In these instances, we report not only screening rates but also process measures to ensure that we capture the underlying activities and procedures that were affected by the interventions so lessons learned can be shared. In addition, we capture the cost of all interventions to identify the resources required for different combinations of interventions and also to generate incremental cost-effectiveness ratios.…”

Identifying optimal approaches to implement colorectal cancer screening through participation in a learning laboratory

“…In this effort, the CDC works intensively with 4 or 5 awardee programs for a specified period of time to complete multiple studies and then transitions to support a new group of programs participating in the learning laboratory. The current series presents findings from the first set of 4 awardee programs in a series of 4 articles along with a methods article describing the data collection and analytic procedures used to perform comprehensive assessments . Table provides an overview of these awardees.…”

“…The current series presents findings from the first set of 4 awardee programs in a series of 4 articles along with a methods article describing the data collection and analytic procedures used to perform comprehensive assessments. [10][11][12][13][14] Table 1 provides an overview of these awardees.The results presented by the Washington State Department of Health and the Colorado Department of Public Health and Environment provide valuable evidence that EBIs implemented in real-world settings can increase CRC screening, even among the diverse, low-income populations seeking health care at FQHCs. In Washington State, the mailed fecal immunochemical test (FIT) program had a test return rate of 31% with an average intervention cost of $18.76 per FIT kit returned (this does not include the cost of purchasing the kit or processing returned kits).…”

“…The current series presents findings from the first set of 4 awardee programs in a series of 4 articles along with a methods article describing the data collection and analytic procedures used to perform comprehensive assessments. [10][11][12][13][14] Table 1 provides an overview of these awardees.…”