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Electronic health record tool helps identify FIT screening candidates
Health care centers that used an electronic health care record-embedded tool to help identify patients eligible for colorectal cancer screening improved their screening rates using mailed fecal immunochemical tests, according to research published in JAMA Internal Medicine.
Gloria D. Coronado, PhD, of Kaiser Permanente Center for Health Research in Portland, Oregon, and colleagues wrote that CRC screening rates remain low, particularly among underserved groups served by federally qualified health centers.
“In [federally qualified health centers] nationally, only 40% of eligible adults were up-to-date for CRC screening in 2016,” they wrote. “Research is needed on how to realize the full potential of routine screening to detect and prevent CRC.”
Coronado and colleagues sought to determine the effectiveness of an EHR-embedded FIT outreach program by randomly assigning 26 federally qualified health care centers to either continue their usual standard care (n = 13) or intervention of their CRC screening program (n = 13).
Researchers designed the EHR-embedded tool to identify eligible adults and to facilitate a stepwise intervention involving an introductory letter, a mailed FIT and a reminder letter. The goal of the program was to make this process part of the health care center’s standard care.
The study comprised 41,193 patients (mean age, 58.5, 22,994 women) overdue for CRC screening. Investigators assessed effectiveness by measuring the clinic-level proportions of adults who completed a FIT. The secondary outcome measure was any CRC screening within 12 months of accrual.
Clinics that implemented the FIT mailing process had significantly higher adjusted clinic-level proportions of patients who completed a FIT (13.9% vs. 10.4%; difference 3.4%; 95% CI, 0.1%–6.8%) and any CRC screening (18.3% vs. 14.5%; difference 3.8%; 95% CI, 0.6%–7%).
Of 21,134 patients in the intervention arm, 6,925 were mailed an introductory letter (33%), 6,308 of those patients ordered a FIT (91%), and 4,074 of those were mailed a reminder letter (59%).
Coronado and colleagues wrote that the EHR tools helped identify patients in real-time and updated information daily.
Though promising, the authors noted that there were smaller intervention effects than previous studies.
“Our pilot FIT outreach program resulted in a 38% boost in FIT completion rates. The smaller effect in this full trial may reflect the efficacy-effectiveness gap, where the ideal effect of an intervention is attenuated by conditions in the actual health care system,” they wrote.
They suggested this was due to competing priorities, time burden, new technology, leadership turnover and the real-time nature of the tool, which did gloss over those patients who did not visit the clinic within the previous year.
“These real-time tools were preferred by clinic leaders because patients’ information, including screening status, continually changes and because they could integrate with day-to-day care and be adapted to address other preventative health care needs,” they wrote. “This work demonstrates that mailed FIT outreach programs can have clinical impact when integrated into clinical work flows but emphasizes the need to identify additional strategies to support program implementation in low-resource health centers.” – by Alex Young
Disclosures: Coronado reports having served as a co-investigator on a previous study funded by EpiGenomics and as principal investigator on a previous study funded by Quidel Corporation. Please see the full study for additional relevant financial disclosures.