title: Outreach for Annual Colorectal Cancer Screening: A Budget Impact Analysis for Community Health Centers.
abstract: BACKGROUND
  Fecal immunochemical testing (FIT) is an attractive approach for colorectal cancer screening at community health centers. This budget impact analysis investigated benefits and costs of FIT outreach-with FIT kits mailed to patients, followed by reminders and phone calls-compared with point-of-care (POC) strategies.
  
  
  METHODS
  Five screening and cost outcomes were simulated over 1 year at a "base case" community health center serving 1000 screening-eligible patients: (1) FIT completion among patients due for screening; (2) proportion up-to-date on screening; (3) cost per patient due for screening; (4) cost per completed FIT; and (5) total organizational cost. Uncertainty analysis investigated potential savings from optimizing staff workflows during FIT outreach. Data were collected in 2012-2014, with analysis conducted 2014-2015.
  
  
  RESULTS
  Using POC strategies, 24.0% of patients due for screening completed FIT, versus 42.4% under outreach (18.4% absolute difference). When calculations included patients up-to-date on screening from prior colonoscopy, 41.7% were up-to-date via POC, versus 55.8% for outreach (14.1% absolute difference). POC cost $4.93 per patient, versus $30.43 for outreach ($25.50 difference). Cost per patient screened was $20.60 for POC and $71.84 for outreach ($51.24 difference). Total organizational cost was $3,779 for POC distribution and $23,315 for outreach ($19,536 difference). Outreach costs decreased by approximately one fourth under optimized workflows.
  
  
  CONCLUSIONS
  Outreach is an effective, practical, relatively low-cost strategy; costs could be reduced further by optimizing staff workflows. Despite its value, outreach costs more than POC distribution and may be difficult for community health centers to implement under current payment models.
authors.affiliation: Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Advancing Equity in Clinical Preventive Services, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: david.liss@northwestern.edu.
authors.forename: David T
authors.initials: DT
authors.lastname: Liss
authors.affiliation: Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Veterans Affairs Health Services Research and Development Service, Chicago, Illinois.
authors.forename: Dustin D
authors.initials: DD
authors.lastname: French
authors.affiliation: Erie Family Health Center, Chicago, Illinois.
authors.forename: David R
authors.initials: DR
authors.lastname: Buchanan
authors.affiliation: Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Advancing Equity in Clinical Preventive Services, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Brown
authors.affiliation: Erie Family Health Center, Chicago, Illinois.
authors.forename: Bridget G
authors.initials: BG
authors.lastname: Magner
authors.affiliation: Erie Family Health Center, Chicago, Illinois.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Kollar
authors.affiliation: Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Center for Advancing Equity in Clinical Preventive Services, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003151:Community Health Centers / Q000191:economics* / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods*; D005243:Feces / Q000737:chemistry*; D006293:Health Promotion / Q000191:economics; D006801:Humans; D007150:Immunohistochemistry; D019095:Point-of-Care Systems / Q000191:economics