Automated intervention to increase uptake of colorectal cancer screening

This month's issue of the Annals of Internal Medicine evaluates an automated intervention with stepped increases in support to increase uptake of colorectal cancer screening.

Screening decreases colorectal cancer incidence and mortality, yet almost half of age-eligible patients are not screened at recommended intervals.

Dr Green and colleagues from Washington, USA determined whether interventions using electronic health records, automated mailings, and stepped increases in support improve colorectal cancer screening adherence over 2 years.

The team performed a 4-group, parallel-design, randomized, controlled comparative effectiveness trial with concealed allocation and blinded outcome assessments.

The researchers evaluated 21 primary care medical centers.

The team evaluated 4675 adults aged 50 to 73 years not current for colorectal cancer screening.

The rapid growth of electronic health records provides opportunities for spreading this model

Annals of Internal Medicine

Usual care, electronic health records-linked mailings (“automated”), automated plus telephone assistance (“assisted”), or automated and assisted plus nurse navigation to testing completion or refusal (“navigated”).

Interventions were repeated in year 2.

The proportion of participants current for screening in both years, defined as colonoscopy or sigmoidoscopy or fecal occult blood testing (FOBT) in year 1 and FOBT, colonoscopy, or sigmoidoscopy.

Compared with those in the usual care group, participants in the intervention groups were more likely to be current for colorectal cancer screening for both years with significant increases by intensity, automated, assisted, and navigated.
 
Increases in screening were primarily due to increased uptake of FOBT being completed in both years.

Dr Green's team concludes, "Compared with usual care, a centralized, electronic health records-linked, mailed colorectal cancer screening program led to twice as many persons being current for screening over 2 years."

"Assisted and navigated interventions led to smaller but significant stepped increases compared with the automated intervention only."

"The rapid growth of electronic health records provides opportunities for spreading this model broadly."