Evaluation of Interventions Intended to Increase Colorectal Cancer Screening Rates in the United States

Dougherty, Michael; Brenner, Alison T.; Crockett, Seth D.; Gupta, Shivani; Wheeler, Stephanie B.; Coker‐Schwimmer, Manny; Cubillos, Laura; Malo, Teri L.; Reuland, Daniel

doi:10.1001/jamainternmed.2018.4637

Cited by 245 publications

(296 citation statements)

References 124 publications

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“…The 2 health plans in the current study used distinct models for delivering mailed FIT programs, with patient populations that were similar with regard to age, sex, insurance status, and race/ethnicity. 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%) .…”

Section: Discussionsupporting

confidence: 82%

“…Directly mailing fecal immunochemical tests (FITs) to patients who are due for colorectal cancer (CRC) screening has been shown to improve CRC screening rates in several health care settings, with meta‐analyses demonstrating a 22% increase in FIT completion rates . Our previous research has demonstrated both the benefits of mailed FIT interventions and the implementation challenges faced by health centers when conducting such programs, including a high burden on staff, competing clinical demands, and a lack of continuity due to leadership and staff turnover .…”

Section: Introductionmentioning

confidence: 99%

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

Coronado

Green

West

et al. 2019

Cancer

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BACKGROUND:Colorectal cancer screening uptake is low, particularly among individuals enrolled in Medicaid. To the authors' knowledge, little is known regarding the effectiveness of direct-to-member outreach by Medicaid health insurance plans to raise colorectal cancer screening use, nor how best to deliver such outreach. METHODS: BeneFIT is a hybrid implementation-effectiveness study of 2 program models that health plans developed for a mailed fecal immunochemical test (FIT) intervention. The programs differed with regard to whether they used a centralized approach (Health Plan Washington) or collaborated with health centers (Health Plan Oregon). The primary implementation outcome of the current study was the percentage of eligible enrollees to whom the plans delivered each intervention component. The primary effectiveness outcome was the rate of FIT completion within 6 months of mailing of the introductory letter. RESULTS: The health plans identified 12,000 eligible enrollees (8551 in Health Plan Washington and 3449 in Health Plan Oregon). Health Plan Washington mailed an introductory letter and FIT kit to 8551 enrollees (100%) and delivered a reminder call to 839 (10.3% of the 8132 attempted). Health Plan Oregon mailed an introductory letter, and a letter and FIT kit plus a reminder postcard to 2812 enrollees (81.5%) and 2650 enrollees (76.8%), respectively. FIT completion rates were 18.2% (1557 of 8551 enrollees) in Health Plan Washington. In Health Plan Oregon, completion rates were 17.4% (488 of 2812 enrollees) among enrollees who were mailed an introductory letter and 18.3% (484 of 2650 enrollees) among enrollees who also were mailed a FIT kit plus reminder postcard. CONCLUSIONS: The implementation of mailed FIT outreach by health plans may be effective and could reach many individuals at risk of developing colorectal cancer. Cancer 2020;126:540-548.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

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

Coronado

Green

West

et al. 2019

Cancer

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“…Mailing fecal immunochemical test (FIT) kits to patients who are due for CRC screening is an evidence-based strategy for increasing CRC screening that has been tested by clinics and health care systems [4][5][6][7][8][9] (e.g., CRC screening rates have increased from 26.3 to 50.8% in primary care clinics in a large nonprofit health care delivery system [8], from 17.8 to 56.5% in rural family physician offices [9]). Health insurance plans are now beginning to implement mailed FIT screening programs [10].…”

Section: Introductionmentioning

confidence: 99%

First-year implementation of mailed FIT colorectal cancer screening programs in two Medicaid/Medicare health insurance plans: qualitative learnings from health plan quality improvement staff and leaders

Baldwin

Schneider

Schwartz

et al. 2020

BMC Health Serv Res

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Background: Colorectal cancer screening rates remain low, especially among certain racial and ethnic groups and the uninsured and Medicaid insured. Clinics and health care systems have adopted population-based mailed fecal immunochemical testing (FIT) programs to increase screening, and now health insurance plans are beginning to implement mailed FIT programs. We report on challenges to and successes of mailed FIT programs during their first year of implementation in two health plans serving Medicaid and dual eligible Medicaid/Medicare enrollees.Methods: This qualitative descriptive study gathered data through in-depth interviews with staff and leaders at each health plan (n = 10). The Consolidated Framework for Implementation Research, field notes from program planning meetings between the research team and the health plans, and internal research team debriefs informed interview guide development. Qualitative research staff used Atlas.ti to code the health plan interviews and develop summary themes through an iterative content analysis approach.Results: We identified first-year implementation challenges in five thematic areas: 1) program design, 2) vendor experience, 3) engagement/communication, 4) reaction/satisfaction of stakeholders, and 5) processing/returning of mailed kits. Commonly experienced challenges by both health plans related to the time-consuming nature of the programs to set up, and complexities and delays in working with vendors. We found implementation successes in the same five thematic areas as well as four additional areas of: 1) leadership support, 2) compatibility with the health plan, 3) broader impacts, and 4) collaboration with researchers. Commonly experienced successes included the ability to adapt the mailed FIT program to the individual health plan culture and needs, and the synchronicity between the programs and their organizational missions and goals. Conclusions: Both health plans successfully adapted mailed FIT programs to their own culture and resources and used their strong quality management resources to maximize success in overcoming the time demands of setting up the program and working with their vendors. Mailed FIT programs administered by health plans, especially those serving Medicaid-and dual eligible Medicaid/Medicare-insured populations, may be an important resource to support closing gaps in colorectal cancer screening among traditionally underserved populations.

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“…5,7 In a recent (2018) review of interventions to increase CRC screening, patient navigation, particularly within the context of multicomponent interventions, was associated with increased screening for CRC. 8 An earlier (2011) review of patient navigation specifically for SC found that although navigation increased SC rates overall, only approximately 36.4% of Latino patients received colonoscopy when using patient navigation compared with 44.4% of white patients. 9 Furthermore, even with patient navigation, national screening rates Cancer February 15, 2020 are reported to remain below the National Colorectal Cancer Roundtable goal of 80% by 2018.…”

Section: Introductionmentioning

confidence: 99%

Promoting colonoscopy screening among low‐income Latinos at average risk of colorectal cancer: A randomized clinical trial

DuHamel

Schofield

Villagra

et al. 2019

Cancer

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BACKGROUND: Screening colonoscopy (SC) for colorectal cancer (CRC) is underused by Latino individuals. The current randomized clinical trial examined the impact of 3 interventions: 1) patient navigation; 2) patient navigation plus standard Centers for Disease Control and Prevention print materials; and 3) patient navigation plus culturally targeted print materials for Latinos referred for SC. Demographic, personal and health history, and psychometric factors associated with SC also were examined. METHODS: A total of 344 urban Latino individuals aged 50 to 85 years with no personal and/or immediate family history of CRC diagnosed before age 60 years, no personal history of a gastrointestinal disorder, no colonoscopy within the past 5 years, with insurance coverage, and with a referral for SC were consented. Participants were randomized to patient navigation (20%), patient navigation plus standard Centers for Disease Control and Prevention print materials (40%), and patient navigation plus culturally targeted print materials (40%). The completion of SC was assessed at 12 months. RESULTS: The interventions had an overall SC rate of 82%. Counterintuitively, patients with an average income of <$10,000 were found to have higher SC rates (87%) than those with a greater income (75%). CONCLUSIONS: The addition of standard or culturally targeted print materials did not appear to increase SC rates above those for patient navigation. Indeed, after controlling for other variables, culturally targeted print materials were found to be associated with lower SC rates among Puerto Rican individuals. Cancer 2020;126:782-791.

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Evaluation of Interventions Intended to Increase Colorectal Cancer Screening Rates in the United States

Abstract: IMPORTANCE Colorectal cancer screening (CRC) is recommended by all major US medical organizations but remains underused.OBJECTIVE To identify interventions associated with increasing CRC screening rates and their effect sizes.

Cited by 245 publications

References 124 publications

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

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

First-year implementation of mailed FIT colorectal cancer screening programs in two Medicaid/Medicare health insurance plans: qualitative learnings from health plan quality improvement staff and leaders

Promoting colonoscopy screening among low‐income Latinos at average risk of colorectal cancer: A randomized clinical trial

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