title: Strategies and opportunities to STOP colon cancer in priority populations: pragmatic pilot study design and outcomes.
abstract: BACKGROUND
  Colorectal-cancer is a leading cause of cancer death in the United States, and Latinos have particularly low rates of screening. Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) is a partnership among two research institutions and a network of safety net clinics to promote colorectal cancer screening among populations served by these clinics. This paper reports on results of a pilot study conducted in a safety net organization that serves primarily Latinos.
  
  
  METHODS
  The study assessed two clinic-based approaches to raise rates of colorectal-cancer screening among selected age-eligible patients not up-to-date with colorectal-cancer screening guidelines. One clinic each was assigned to: (1) an automated data-driven Electronic Health Record (EHR)-embedded program for mailing Fecal Immunochemical Test (FIT) kits (Auto Intervention); or (2) a higher-intensity program consisting of a mailed FIT kit plus linguistically and culturally tailored interventions delivered at the clinic level (Auto Plus Intervention). A third clinic within the safety-net organization was selected to serve as a passive control (Usual Care). Two simple measurements of feasibility were: 1) ability to use real-time EHR data to identify patients eligible for each intervention step, and 2) ability to offer affordable testing and follow-up care for uninsured patients.
  
  
  RESULTS
  The study was successful at both measurements of feasibility. A total of 112 patients in the Auto clinic and 101 in the Auto Plus clinic met study inclusion criteria and were mailed an introductory letter. Reach was high for the mailed component (92.5% of kits were successfully mailed), and moderate for the telephone component (53% of calls were successful completed). After exclusions for invalid address and other factors, 206 (109 in the Auto clinic and 97 in the Auto Plus clinic) were mailed a FIT kit. At 6 months, fecal test completion rates were higher in the Auto (39.3%) and Auto Plus (36.6%) clinics compared to the usual-care clinic (1.1%).
  
  
  CONCLUSIONS
  Findings showed that the trial interventions delivered in a safety-net setting were both feasible and raised rates of colorectal-cancer screening, compared to usual care. Findings from this pilot will inform a larger pragmatic study involving multiple clinics.
  
  
  BACKGROUND
  ClinicalTrial.gov: NCT01742065.
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, USA. gloria.d.coronado@kpchr.org.
authors.forename: Gloria D
authors.initials: GD
authors.lastname: Coronado
authors.forename: William M
authors.initials: WM
authors.lastname: Vollmer
authors.forename: Amanda
authors.initials: A
authors.lastname: Petrik
authors.forename: Josue
authors.initials: J
authors.lastname: Aguirre
authors.forename: Tanya
authors.initials: T
authors.lastname: Kapka
authors.forename: Jennifer
authors.initials: J
authors.lastname: Devoe
authors.forename: Jon
authors.initials: J
authors.lastname: Puro
authors.forename: Tran
authors.initials: T
authors.lastname: Miers
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lembach
authors.forename: Ann
authors.initials: A
authors.lastname: Turner
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sanchez
authors.forename: Sally
authors.initials: S
authors.lastname: Retecki
authors.forename: Christine
authors.initials: C
authors.lastname: Nelson
authors.forename: Beverly
authors.initials: B
authors.lastname: Green
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000379:methods*; D057286:Electronic Health Records; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011159:Population Surveillance / Q000379:methods*; D016896:Treatment Outcome