Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial

Abstract

A health department-based, mailed FIT program targeting Medicaid beneficiaries was feasible. Including a FIT kit resulted in greater screening completion than a reminder letter alone. Further research is needed to understand the comparative cost-effectiveness of these interventions.

Direct‐to‐member mailed colorectal cancer screening outreach for Medicaid and Medicare enrollees: Implementation and effectiveness outcomes from the BeneFIT study

“…The FIT return rates achieved in the current study were similar to those achieved in some clinic‐based studies of mailed FIT outreach, suggesting that health plan–based, mailed FIT programs can be as effective as programs initiated by individual clinics or health centers. The current study findings also are approximately consistent with those of a previous investigation of a CRC screening intervention by Medicaid health plans, in which Brenner et al reported a return rate of 21% for a centralized FIT program for Medicaid enrollees that first removed those enrollees who had an invalid address (19%) or self‐reported recent screening (11%) . The findings of the current study demonstrated completion rates to be particularly high in Health Plan Washington among enrollees who were due for and answered the live reminder telephone call (76.2%); these findings were consistent with previous research indicating that tailored telephone outreach can significantly increase rates of CRC screening .…”

“…Nevertheless, the current study data from Health Plan Oregon have suggested lower than expected numbers of invalid addresses; only 83 of 3449 addresses (2.4%) initially were determined to be invalid based on US Postal Service records and an additional 157 of 2812 addresses (5.6%) were removed after the introductory letter was mailed. In contrast, Brenner et al reported a 19% rate of invalid addresses among Medicaid enrollees in North Carolina . More research is needed to understand and address these and other implementation challenges.…”

“…Other factors, such as unestablished care, low understanding of the need for a follow‐up colonoscopy, or other reported obstacles to colonoscopy (eg, bowel preparation, the need to take time away from work, procedure costs) may contribute further . In contrast, Brenner et al reported a 66% rate of follow‐up colonoscopy when the health plan care coordinator was able to view enrollees' medical records and directly discuss FIT results with the enrollees . These and other innovations to increase follow‐up colonoscopy rates are critical to the success of mailed FIT interventions.…”

“…To the best of our knowledge, few previous investigations have assessed the effectiveness of a health insurance plan–based mailed FIT outreach program, nor have any assessed how best to implement such a program. Brenner et al reported a FIT completion rate of 21% for a centralized FIT program that mailed to >1000 Medicaid enrollees in a large county health department . This study, however, was designed to determine efficacy under ideal circumstances (eg, programs designed and delivered by researchers rather than health plan staff).…”

What’s the “Secret Sauce”? How Implementation Variation Affects the Success of Colorectal Cancer Screening Outreach

“…This nding that more comprehensive efforts yielded higher screening rates supports prior research suggesting that FIT return rates can be increased by delivering more and additional types of reminders. [29][30][31] The con gurational analyses identi ed multiple ways for health systems to achieve higher rates of screening. It found size to be an important contextual factor, with different solutions for larger health systems than those for smaller health systems.…”