title: Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: a randomized clinical trial.
abstract: OBJECTIVE
  Colorectal cancer (CRC) screening rates are lower among Latinos and people living in poverty. Fecal occult blood testing (FOBT) is one recommended screening modality that may overcome cost and access barriers. However, the ability of FOBT to reduce CRC mortality depends on high rates of adherence to annual screening.
  
  
  OBJECTIVE
  To determine whether a multifaceted intervention increases adherence to annual FOBT compared with usual care.
  
  
  METHODS
  Patient-level randomized controlled trial conducted in a network of community health centers. Included were 450 patients who had previously completed a home FOBT from March 2011 through February 2012 and had a negative test result: 72% of participants were women; 87% were Latino; 83% stated that Spanish was their preferred language; and 77% were uninsured.
  
  
  METHODS
  Usual care at participating health centers included computerized reminders, standing orders for medical assistants to give patients home fecal immunochemical tests (FIT), and clinician feedback on CRC screening rates. The intervention group also received (1) a mailed reminder letter, a free FIT with low-literacy instructions, and a postage-paid return envelope; (2) an automated telephone and text message reminding them that they were due for screening and that a FIT was being mailed to them; (3) an automated telephone and text reminder 2 weeks later for those who did not return the FIT; and (4) personal telephone outreach by a CRC screening navigator after 3 months.
  
  
  METHODS
  Completion of FOBT within 6 months of the date the patient was due for annual screening.
  
  
  RESULTS
  Intervention patients were much more likely than those in usual care to complete FOBT (82.2% vs 37.3%; P < .001). Of the 185 intervention patients completing screening, 10.2% completed prior to their due date (intervention was not given), 39.6% within 2 weeks (after initial intervention), 24.0% within 2 to 13 weeks (after automated call/text reminder), and 8.4% between 13 and 26 weeks (after personal call).
  
  
  CONCLUSIONS
  This intervention greatly increased adherence to annual CRC screening; most screenings were achieved without personal calls. It is possible to improve annual CRC screening for vulnerable populations with relatively low-cost strategies that are facilitated by health information technologies.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01453894.
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern Un.
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern Un.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Brown
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois4Erie Family Health Center, Chicago, Illinois.
authors.forename: David R
authors.initials: DR
authors.lastname: Buchanan
authors.affiliation: Erie Family Health Center, Chicago, Illinois.
authors.forename: Jordan
authors.initials: J
authors.lastname: Weil
authors.affiliation: Erie Family Health Center, Chicago, Illinois.
authors.forename: Kate
authors.initials: K
authors.lastname: Balsley
authors.affiliation: Erie Family Health Center, Chicago, Illinois.
authors.forename: Lauren
authors.initials: L
authors.lastname: Ranalli
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern Un.
authors.forename: Kenzie A
authors.initials: KA
authors.lastname: Cameron
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: M Rosario
authors.initials: MR
authors.lastname: Ferreira
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Quinn
authors.initials: Q
authors.lastname: Stephens
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern Un.
authors.forename: Shira N
authors.initials: SN
authors.lastname: Goldman
authors.affiliation: Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois6Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Alred
authors.initials: A
authors.lastname: Rademaker
authors.affiliation: Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Center for Advancing Equity in Clinical Preventive Services, Feinberg School of Medicine, Northwestern Un.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
mesh_terms: D000368:Aged; D002641:Chicago; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003151:Community Health Centers; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017010:Reminder Systems