Effectiveness and Cost of Implementing Evidence-Based Interventions to Increase Colorectal Cancer Screening Among an Underserved Population in Chicago

Abstract

With funding from the Centers for Disease Control and Prevention’s Colorectal Cancer Control Program, The University of Chicago Center for Asian Health Equity partnered with a federally qualified health center (FQHC) to implement multiple evidence-based interventions (EBIs) in order to improve colorectal cancer (CRC) screening uptake. The purpose of this study is to determine the effectiveness and cost of implementing a provider reminder system entered manually and supplemented with patient reminders and provider assessment and feedback. The FQHC collected demographic characteristics of the FQHC and outcome data from January 2015 through December 2015 (preimplementation period) and cost from January 2016 through September 2017 (implementation period). Cost data were collected for the implementation period. We report on the demographics of the eligible population, CRC screening order, completion rates by sociodemographic characteristics, and, overall, the effectiveness and cost of implementation. From the preimplementation phase to the implementation phase, there was a 21.2 percentage point increase in CRC screens completed. The total cost of implementing EBIs was $40908.97. We estimated that an additional 283 screens were completed because of the interventions, and the implementation cost of the interventions was $144.65 per additional screen. With the interventions, CRC screening uptake in Chicago increased for all race/ethnicity and demographic backgrounds at the FQHC, particularly for patients aged 50 to 64 years and for Asian, Hispanic, and uninsured patients.

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).…”

“…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). Costs at LFC were driven primarily by the time spent by patient navigators to track and contact patients.…”

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

“…The University of Chicago and Heartland Health Centers in Chicago implemented a provider reminder system based on the electronic medical records but input manually. This intervention, implemented at the health system level, was supplemented with patient reminders and provider assessment and feedback across eight clinic sites (Kim et al, 2020). The California Depart ment of Public Health with its partner, Neighborhood Healthcare, implemented a provider incentive program (payments were offered to support staff at the clinics when predetermined screening targets were met), including patient and provider reminders, to supplement ongoing interventions (Barajas et al, 2020).…”

“…Each study involved multicomponent interventions and offered lessons for successful implementation and scale-up of future programs to increase CRC screening uptake. Details are presented in the accompanying research briefs (Barajas et al, 2020;Conn et al, 2020;Hardin et al, 2020;Kim et al, 2020). Table 2 shows the summary cost data from each study.…”