Cost and Effectiveness of Reminders to Promote Colorectal Cancer Screening Uptake in Rural Federally Qualified Health Centers in West Virginia

Abstract

The purpose of this study is to evaluate the effectiveness of the West Virginia Program to Increase Colorectal Cancer Screening in implementing patient reminders to increase fecal immunochemical test (FIT) kit return rates in nine federally qualified health centers (FQHCs). Using process measures and cost data collected, the authors examined the differences in the intensity of the phone calls across FQHCs and compared them with the return rates achieved. They also reported the cost per kit successfully returned as a result of the intervention. Across all FQHCs, 5,041 FIT kits were ordered, and the initial return rate (without a reminder) was 41.1%. A total of 2,201 patients received reminder phone calls; on average, patients received 1.61 reminder calls each. The reminder interventions increased the average FIT kit return rate to 60.7%. The average total cost per FIT kit returned across all FQHCs was $60.18, and the average cost of only the reminders was $11.20 per FIT kit returned. FQHCs achieved an average increase of 19.6 percentage points in FIT kit return rates, and costs across clinics varied. Clinics with high-quality health information systems that enabled tracking of patients with minimal effort were able to implement lower cost reminder interventions.

The Effectiveness and Cost to Improve Colorectal Cancer Screening in a Federally Qualified Homeless Clinic in Eastern Kentucky

“…This study demonstrated that modest financial incentives, together with patient navigation and patient reminders, can increase FIT kit return rates among a vulnerable rural, largely homeless population. The incremental cost per person screened was also estimated to be within the parameters found in our previous studies (Conn et al, 2020;Kim et al, 2020). The results supplement recommendations of The Community Guide, which recommends multicomponent, evidence-based interventions to promote CRC screening as a key strategy for eliminating disparities in cancer prevention and control (Community Preventive Services Task Force, 2012;Sabatino et al, 2012).…”

“…As noted, the incremental cost was approximately $128 per additional screen at LFC. Our previous research in other settings has shown a wide range of incremental costs per additional CRC screen (Conn et al, 2020;Kim et al, 2020). In rural health centers in West Virginia that were implementing a multicomponent intervention (patient and provider reminders with patient assessment and feedback), we found the average cost per FIT kit returned to be approximately $60 (Conn et al, 2020).…”

“…Our previous research in other settings has shown a wide range of incremental costs per additional CRC screen (Conn et al, 2020;Kim et al, 2020). In rural health centers in West Virginia that were implementing a multicomponent intervention (patient and provider reminders with patient assessment and feedback), we found the average cost per FIT kit returned to be approximately $60 (Conn et al, 2020). In contrast, we calculated the incremental costs of an additional screen in 133 FQHCs in Chicago utilizing primarily a physician reminder intervention to be approximately $145 (Kim et al, 2020).…”

Examining the Effectiveness of Provider Incentives to Increase CRC Screening Uptake in Neighborhood Healthcare: A California Federally Qualified Health Center

“…During the study period, from July 2015 to December 2017, all health centers, except for one, experienced an increase in FIT kit return rates. In prior analyses, our team reported a wide range in the percentage of FIT kit returns at health centers from 31.0% to 81.6% (Conn et al, 2020;Kemper et al, 2018); the percentage of FIT kit returns in Neighborhood Healthcare centers was definitely on the high end of this range with percentages from 72.4% to 88.5% during the 6 months from July to December 2017. The percentage of FIT kit returns was already quite high, 75.1%, before the incentive program, which could be a result of the multicomponent interventions already implemented in the clinics.…”

Economic Evaluation of Interventions to Increase Colorectal Cancer Screening at Federally Qualified Health Centers

“…West Virginia University worked with its FQHC partners to implement provider assessment and feedback in addition to at least one other EBI. We focused on sites that added patient reminders to increase FIT kit return rates (Conn et al, 2020). The University of Chicago and Heartland Health Centers in Chicago implemented a provider reminder system based on the electronic medical records but input manually.…”