Impact of continued mailed fecal tests in the patient-centered medical home: Year 3 of the Systems of Support to Increase Colon Cancer Screening and Follow-Up randomized trial.
BACKGROUND
The current study was conducted to determine the effect of continuing a centralized fecal occult blood test (FOBT) mailed program on screening adherence.


METHODS
A patient-level randomized controlled trial was conducted in 21 patient-centered medical home primary care clinics between January 2010 and November 2012. A total of 2208 patients ranging in age from 52 to 75 years in a substudy of the Systems of Support to Increase Colon Cancer Screening and Follow-Up (SOS) trial were randomized at year 3 to continued automated interventions (Continued group), which included mailed information regarding colorectal cancer (CRC) screening choices, and were mailed stool kit tests or to a group in which interventions were stopped (Stopped group). The main outcomes and measures were the completion of CRC screening in year 3 and by subgroup characteristics, respectively.


RESULTS
Adherence to CRC screening in year 3 was found to be significantly higher in patients in the Continued group compared with those in the Stopped group (53.3% vs 37.3%; adjusted net difference, 15.6% [P<.001]). This difference was entirely due to greater completion of FOBT (adjusted net difference, 18.0% [P<.001]). Year 3 CRC screening rates were highest in patients in the Continued group completing FOBT in both years 1 and 2 (77.2%), followed by patients completing only 1 FOBT in 1 of the 2 years (44.6%), with low rates of CRC testing reported among patients not completing any FOBT within the first 2 years (18.1%).


CONCLUSIONS
A centralized mailed FOBT CRC screening program continued to be more effective than patient-centered medical home usual-care interventions, but only for those patients who had previously completed FOBT testing. Research is needed regarding how to engage patients not completing CRC testing after being mailed at least 2 rounds of FOBT tests. Cancer 2016;122:312-321. © 2015 American Cancer Society.
Group Health Permanente, Seattle, Washington.|Group Health Research Institute, Seattle, Washington.|Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington.
Beverly B
BB
Green
Group Health Research Institute, Seattle, Washington.
Melissa L
ML
Anderson
Group Health Research Institute, Seattle, Washington.|University of Washington School of Public Health, Seattle, Washington.
Jessica
J
Chubak
Group Health Research Institute, Seattle, Washington.
Sharon
S
Fuller
Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon.
Richard T
RT
Meenan
School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas.
Sally W
SW
Vernon
D000367:Age Factors; D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000379:methods*; D005243:Feces; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009780:Occult Blood; D010349:Patient Compliance / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000379:methods*; D011177:Postal Service; D017010:Reminder Systems; D012737:Sex Factors; D013997:Time Factors; D014481:United States
colonoscopy; colorectal cancer screening; complete diagnostic evaluation; navigation