Intervention improves follow-up of abnormal cancer screening results in primary care

Key takeaways:

• A combination of EHR reminders, outreach and help by a patient navigator improved follow-up rates.
• The costs of outreach efforts are “likely modest,” an expert said.

An intervention consisting of electronic health record reminders and patient outreach improved follow-up completion of overdue abnormal cancer screening results, a study in JAMA Network Open showed.

“There is considerable interest in cancer prevention. Maximizing the benefits of screening for cancer requires efforts to ensure everyone is screened and those with abnormal results are followed up.” Steven J. Atlas, MD, MPH, an associate professor of medicine at Harvard Medical School, told Healio. “However, timely follow-up of abnormal cancer screening results is not always achieved.”

The researchers created a multilevel intervention centered around EHR-automated reminders and other strategies.

The intervention was conducted across 44 primary care clinics “because primary care clinicians take a ‘whole person’ approach and are responsible for a wide range of preventive health efforts, including cancer screening and follow-up of test results,” Atlas said in a press release.

The total cohort included 11,980 patients who had received abnormal breast cancer, cervical cancer, colorectal cancer or lung cancer screening results.

Practices and their patients were randomly assigned in a 1:1:1:1 ratio to one of four exposure groups, including:

• usual care;
• EHR reminders;
• EHR reminders and outreach (consisting of a patient letter and phone call); and
• EHR reminders, outreach and navigation (in the form of a follow-up call by a patient navigator).

Overall, the proportion of patients who completed follow-up within 120 days of study enrollment was:

• 31.4% in the EHR reminders, outreach and navigation group;
• 31% in the EHR reminders and outreach group;
• 22.9% in the usual care group; and
• 22.7% in the EHR reminders group.

Similar results were seen regarding the completion of follow-up within 240 days, the researchers said, and they were also similar in patient subgroups based on cancer type and the level of risk of the abnormal cancer screening result.

Atlas and colleagues pointed out that, even though the interventions improved follow-up rates, many patients with abnormal test results still did not complete follow-up, “highlighting the need to understand factors associated with not completing follow-up that go beyond reminder efforts.”

“Patient factors may include need for education about the meaning of the test results, what follow-up procedures involve, and assessing patient preferences,” they wrote. “Practitioner factors such as knowledge of guidelines and improved access to prior test results may also be important.”

Atlas noted that although the researchers did not evaluate possible costs of implementing the intervention, “the marginal cost of the population outreach efforts are likely modest.”

“Developing the information technology system is more complex and requires that the health care system have a well-developed infrastructure,” he said.

References:

• Atlas S, et al. JAMA Netw Open. 2023;doi:10.1001/jama.2023.18755.
• Primary care reminder plus patient outreach intervention improved rates of follow-up after abnormal cancer test results. https://www.massgeneral.org/news/press-release/primary-care-reminder-plus-patient-outreach-intervention-improved-rates-of-follow-up-after-abnormal-cancer-test-results. Published Oct. 10, 2023. Accessed Oct. 16, 2023.