The validation of electronic health records in accurately identifying patients eligible for colorectal cancer screening in safety net clinics

Petrik, Amanda F.; Green, Beverly B.; Vollmer, William M.; Le, Thuy; Bachman, Barbara; Keast, Erin; Rivelli, Jennifer S.; Coronado, Gloria D.

doi:10.1093/fampra/cmw065

Cited by 32 publications

(21 citation statements)

References 13 publications

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“…Patients were due for screening if there was no evidence in the electronic health record (EHR) of (a) a fecal test in the previous year, (b) an order for a fecal test in the previous 6 months, (c) a flexible sigmoidoscopy in the previous 4 years, (d) a colonoscopy in the previous 9 years, or (e) an order for a sigmoidoscopy/colonoscopy in the previous year. Patients were excluded if there was EHR evidence of any of several health conditions that made them poor candidates for fecal testing (eg, history of CRC, inflammatory bowel disease, or end‐stage renal failure) …”

Section: Methodsmentioning

confidence: 99%

Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

et al. 2018

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Annual fecal immunochemical testing (FIT) is cost‐effective for colorectal cancer (CRC) screening. However, FIT positivity rates and positive predictive value (PPV) can vary substantially, with false‐positive (FP) results adding to colonoscopy burden without improving cancer detection. Our objective was to describe FIT PPV and the factors associated with FP results among patients undergoing CRC screening. In an ongoing pragmatic clinical trial of mailed‐FIT outreach, clinics delivered one of three FIT brands (InSure, OC‐Micro, and Hemosure). Patients who had a positive FIT result and a follow‐up colonoscopy were included in this analysis (N = 1130). Patients’ demographic and medical histories were abstracted from electronic health records (EHR). Associations with a FP result (ie, a positive FIT result with no evidence of advanced neoplasia during follow‐up colonoscopy) were evaluated for FIT brand and patient factors using mixed‐effects multivariable logistic regression. The mean proportion of FIT‐positive results ranged from 8% in centers using the OC‐Micro test to 21% for Hemosure. PPVs for advanced neoplasia were 0.30 to 0.17, respectively (P for χ 2 = 0.08). In multivariable‐adjusted models, use of Hemosure was associated with greater odds of a FP result than OC‐Micro (OR = 2.00, 95% CI: 0.47‐8.56) or InSure (OR = 1.72, 95% CI: 0.44‐6.68). However, only female sex (OR = 1.58, 95% CI: 1.19‐2.10) and history of a colorectal condition (OR = 2.17, 95% CI: 1.13‐4.15) were significantly associated with FP. In conclusion, FIT positivity varied by brand, and FP results differed by patient factors available through the EHR. These results can be used to minimize the frequency of FP results, reducing patient distress and colonoscopy burden.

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Section: Methodsmentioning

confidence: 99%

Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

et al. 2018

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“…Centralized clinic outreach staff used electronic health record codes developed and refined in STOP CRC to identify adults overdue for CRC screening who had attended a clinic visit within the calendar year. 15 A total of 3462 adults met the criteria and were mailed an introductory letter. Clinic staff identified anyone whose letter was returned by the post office as undeliverable, and reviewed the medical records to identify anyone who was up to date with CRC screening (not captured using health record codes), and removed 740 names.…”

Section: Methodsmentioning

confidence: 99%

Effect of Reminding Patients to Complete Fecal Immunochemical Testing: A Comparative Effectiveness Study of Automated and Live Approaches

et al. 2017

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BackgroundThe Community Preventive Services Task Force recommends multi-component interventions, including patient reminders, to improve uptake of colorectal cancer screening.ObjectiveWe sought to compare the effectiveness of different forms of reminders for a direct-mail fecal immunochemical test (FIT) program.DesignPatient-randomized controlled trial.Participants2772 adults aged 50–75, not up to date with colorectal cancer screening recommendations, with a clinic visit in the previous year at any of four participating health center clinics.InterventionParticipants were mailed an introductory letter and FIT. Those who did not complete their FIT within 3 weeks were randomized to receive (1) a reminder letter, (2) two automated phone calls, (3) two text messages, (4) a live phone call, (5) a reminder letter and a live phone call, (6) two automated phone calls and a live phone call, or (7) two text messages and a live phone call. Patients with a patient portal account were sent two email reminders, but were not randomized.Main MeasuresFIT return rates for each group, 6 months following randomization.Key ResultsA total of 255 (10%) participants returned their FIT within 3 weeks of the mailing. Among randomized participants (n = 2010), an additional 25.5% returned their FITs after reminders were delivered (estimated overall return rate = 32.7%). In intention-to-treat analysis, compared to the group allocated to receive a reminder letter, return rates were higher for the group assigned to receive the live phone call (OR = 1.51 [1.03–2.21]) and lower for the group assigned to receive text messages (OR = 0.66 [0.43–0.99]). Reminder effectiveness differed by language preference.ConclusionsOur data suggest that FIT reminders that included a live call were more effective than reminders that relied solely on written communication (a text message or letter).Trial Registration: ClinicalTrials.gov/ctc2/show/NCT01742065.

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“…Centralized clinic outreach staff used a list of EHR codes (eg, diagnoses codes, procedure codes, and laboratory codes) from previous studies 18 to identify adults who were overdue for CRC screening and had attended at least 2 clinic visits within the past 24 months. 19 A total of 3201 adults in the 2 participating clinics met the criteria. Using this list, clinic staff removed 1218 individuals whose insurance status could not be validated and their patient ("enrollment") status could not be confirmed (n ϭ 990), had an invalid address (n ϭ 107), or were otherwise ineligible, for example, had a total colec-tomy or CRC (n ϭ 147; note that reasons were not mutually exclusive).…”

Section: Study Proceduresmentioning

confidence: 99%

Patient-Refined Messaging for a Mailed Colorectal Cancer Screening Program: Findings from the PROMPT Study

et al. 2019

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Background: Improving uptake of colorectal cancer screening has the potential of saving thousands of lives. We compared the effectiveness of automated and live prompts and reminders as part of a mailed fecal immunochemical test (FIT) outreach program. Design and Methods: Participants were 1767 adults aged 50 to 75 eyars who were not up-to-date with colorectal cancer screening recommendations at a participating community health center clinic. In addition to a mailed FIT kit, participants were randomized to receive (1) a text message prompt and 2 automated phone call reminders (automated condition); (2) up to 3 live call reminders (live condition); or (3) a text message prompt, 2 automated call reminders, and up to 3 live reminders (combined automated plus live condition). We assessed FIT completion rates in each group 6 months following randomization. Key Results: Nearly one-third of participants completed an FIT within 6 months. Compared with adults allocated to the automated condition, FIT completion rates were higher in adults allocated to the live condition (32.3% vs 26.0%; adjusted difference, 6.3 percentage points; 95% CI, 1.1-11.4) and in adults allocated to the combined automated plus live condition (35.7% vs 26.0%; adjusted difference, 9.7 percentage points; 95% CI, 4.4-14.9). The number of kits needed to mail to achieve a completed FIT ranged from 2.8 in the combined automated plus live condition to 3.8 in the automated condition. Conclusions: Among unscreened individuals in this population, live phone call reminders either alone or in combination with automated prompts and reminders outperformed automated approaches alone.

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The validation of electronic health records in accurately identifying patients eligible for colorectal cancer screening in safety net clinics

Cited by 32 publications

References 13 publications

Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

Positive predictive values of fecal immunochemical tests used in the STOP CRC pragmatic trial

Effect of Reminding Patients to Complete Fecal Immunochemical Testing: A Comparative Effectiveness Study of Automated and Live Approaches

Patient-Refined Messaging for a Mailed Colorectal Cancer Screening Program: Findings from the PROMPT Study

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