title: Improving colon cancer screening in community clinics.
abstract: BACKGROUND
  The authors evaluated the effectiveness and cost effectiveness of 2 interventions designed to promote colorectal cancer (CRC) screening in safety-net settings.
  
  
  METHODS
  A 3-arm, quasi-experimental evaluation was conducted among 8 clinics in Louisiana. Screening efforts included: 1) enhanced usual care, 2) literacy-informed education of patients, and 3) education plus nurse support. Overall, 961 average-risk patients ages 50 to 85 years were eligible for routine CRC screening and were recruited. Outcomes included CRC screening completion and incremental cost effectiveness using literacy-informed education of patients and education plus nurse support versus enhanced usual care.
  
  
  RESULTS
  The baseline screening rate was <3%. After the interventions, the screening rate was 38.6% with enhanced usual care, 57.1% with education, and 60.6% with education that included additional nurse support. After adjusting for age, race, sex, and literacy, patients who received education alone were not more likely to complete screening than those who received enhanced usual care; and those who received additional nurse support were 1.60-fold more likely to complete screening than those who received enhanced usual care (95% confidence interval, 1.06-2.42; P = .024). The incremental cost per additional individual screened was $1337 for education plus nurse support over enhanced usual care.
  
  
  CONCLUSIONS
  Fecal occult blood test rates were increased beyond enhanced usual care by providing brief education and nurse support but not by providing education alone. More cost-effective alternatives to nurse support need to be investigated.
authors.affiliation: Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
authors.forename: Terry
authors.initials: T
authors.lastname: Davis
authors.forename: Connie
authors.initials: C
authors.lastname: Arnold
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker
authors.forename: Charles
authors.initials: C
authors.lastname: Bennett
authors.forename: Stacy
authors.initials: S
authors.lastname: Bailey
authors.forename: Daci
authors.initials: D
authors.lastname: Platt
authors.forename: Cristalyn
authors.initials: C
authors.lastname: Reynolds
authors.forename: Dachao
authors.initials: D
authors.lastname: Liu
authors.forename: Edson
authors.initials: E
authors.lastname: Carias
authors.forename: Pat
authors.initials: P
authors.lastname: Bass
authors.forename: Michael
authors.initials: M
authors.lastname: Wolf
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D003151:Community Health Centers / Q000191:economics / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009780:Occult Blood; D010353:Patient Education as Topic / Q000379:methods / Q000706:statistics & numerical data; D010358:Patient Participation; D018579:Patient Selection; D014741:Video Recording
keywords: colorectal cancer screening; community health clinics; fecal occult blood test; federally qualified health centers; literacy; low-income patients
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