title: A system-based intervention to improve colorectal cancer screening uptake.
abstract: OBJECTIVE
  To determine whether mailing guaiac-based fecal occult blood tests (gFOBTs) directly to patients who are due for colorectal cancer screening would achieve higher screening uptake than using visit-based screening.
  
  
  METHODS
  Comparative effectiveness analysis.
  
  
  METHODS
  We used an electronic medical record to identify 7053 New Mexico Veterans Affairs Health Care System patients aged 50 to 80 years who were due for screening in 2008. We invited 3869 randomly selected patients to participate in a randomized controlled trial comparing adherence with different fecal blood tests; 202 intervention patients were assigned to receive mailed gFOBTs. We identified the following 3 control groups who could receive only visit-based colorectal cancer screening: 3184 individuals who were not invited for the randomized controlled trial (control group 1), 2525 individuals who did not respond to invitations to participate in the randomized controlled trial (control group 2), and 255 individuals who could not be contacted (control group 3). We measured gFOBT screening within 3 months after enrollment in the intervention group, as well as gFOBT or colonoscopy screening within 6 months of identification as a control subject. We compared screening across groups using multivariate logistic regression analysis to adjust for sex, race/ethnicity, clinic site, previous gFOBT, and comorbidities.
  
  
  RESULTS
  Colorectal screening occurred less often in each of the control groups (in 18.6% of control group 1, in 14.3% of control group 2, and in 18.8% of control group 3) than among patients mailed a gFOBT (48.5%). Adjusted odds ratios for screening among the control groups were all less than in the intervention group (adjusted odds ratios, 0.25, 0.19, and 0.23, respectively; all, P <.001).
  
  
  CONCLUSIONS
  Using an electronic medical record to identify screening-eligible patients and mailing them gFOBT cards achieved higher colorectal screening uptake than performing visit-based screening.
authors.affiliation: New Mexico VA Health Care System, Albuquerque, 87108, USA. rhoffman@unm.edu
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hoffman
authors.forename: Susan R
authors.initials: SR
authors.lastname: Steel
authors.forename: Ellen F T
authors.initials: EF
authors.lastname: Yee
authors.forename: Larry
authors.initials: L
authors.lastname: Massie
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Schrader
authors.forename: Maurice L
authors.initials: ML
authors.lastname: Moffett
authors.forename: Glen H
authors.initials: GH
authors.lastname: Murata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D057186:Comparative Effectiveness Research; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009516:New Mexico; D009780:Occult Blood; D011320:Primary Health Care / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs