Multi-modal outreach increases colorectal cancer screening rate

Phone calls and mailed fecal immunochemical tests (FITs) resulted in a four-fold increase in the rate of colorectal cancer screening, according to findings published in the July issue of the American Journal of Managed Care.

Almost 60,000 Kaiser Permanente Colorado members unscreened for colorectal cancer received an interactive voice response call followed by a mailed FIT. Forty-five percent of the unscreened population completed screening. The outreach had even greater impact among members without a primary care visit or specialty care visit compared with those with one or more visits, according to Karin L. Kempe, MD, MPH, of the Kaiser Permanente Care Management Institute, and colleagues.

The interactive voice response (IVR) calls lasted approximately five minutes and included options for education about screening modalities. The registry was updated with new information regarding high-risk status, and the member’s provider was notified for colonoscopy referral if requested. Average-risk members who completed the call and requested stool testing were mailed a kit within two weeks. Kits included an invitational letter with information about stool testing, an FIT kit with instructions and a prepaid return envelope. A section in Spanish gave a phone number to call for assistance in Spanish.

Members who did not complete the IVR call were mailed the FIT kit 30 days later. If the kit was not returned, a reminder letter was sent at four weeks. Members with negative FIT results were notified by mail; positive results were sent electronically through the medical record to the primary care provider for referral. Members with positive studies who did not complete diagnostic evaluation received a reminder letter at eight weeks followed by a certified letter at 16 weeks. The program sent yearly FIT tests on the anniversary date of initial testing for members who chose to screen by FIT and remained eligible.

Strengths of this study, according to the researchers, included the setting of an integrated delivery system, the use of a population registry for colorectal cancer screening, the random assignment of the timing of outreach, access to race/ethnicity and disease registries and visit history data.

Although there were concurrent initiatives to support CRC screening as well as efforts to increase public awareness at both the state and national levels, the analysis controlled for these factors by comparing the intervention group with a delayed intervention, temporally matched control group.

From 2006 to 2008, colorectal cancer screening rates among the insured population in Colorado as a whole improved only three points, from 62 percent to 65 percent, but increased for Kaiser Permanente members by 25 percentage points, from 47 percent to 72 percent.

“This analysis demonstrates the effectiveness of a multi-modal population outreach to promote colorectal screening and confirms the need for additional tailored interventions for vulnerable groups,” the authors wrote.