Beverly B. Green|Ching Yun Wang|Melissa L. Anderson|Jessica Chubak|Richard T. Meenan|Sally W. Vernon|Sharon Fuller
An Automated Intervention With Stepped Increases in Support to Increase Uptake of Colorectal Cancer Screening
Fred Hutch Cancer Center|Kaiser Permanente Washington Health Research Institute|University of Washington|Kaiser Permanente Center for Health Research|The University of Texas Health Science Center at Houston|Fred Hutch Cancer Center|Kaiser Permanente Washington Health Research Institute|University of Washington|Kaiser Permanente Center for Health Research|The University of Texas Health Science Center at Houston|Fred Hutch Cancer Center|Kaiser Permanente Washington Health Research Institute|University of Washington|Kaiser Permanente Center for Health Research|The University of Texas Health Science Center at Houston|Fred Hutch Cancer Center|Kaiser Permanente Washington Health Research Institute|University of Washington|Kaiser Permanente Center for Health Research|The University of Texas Health Science Center at Houston|Fred Hutch Cancer Center|Kaiser Permanente Washington Health Research Institute|University of Washington|Kaiser Permanente Center for Health Research|The University of Texas Health Science Center at Houston|Fred Hutch Cancer Center|Kaiser Permanente Washington Health Research Institute|University of Washington|Kaiser Permanente Center for Health Research|The University of Texas Health Science Center at Houston|Fred Hutch Cancer Center|Kaiser Permanente Washington Health Research Institute|University of Washington|Kaiser Permanente Center for Health Research|The University of Texas Health Science Center at Houston
chinese translation background screening decreases colorectal cancer crc incidence mortality yet almost half ageeligible patients screened recommended intervals objective determine whether interventions using electronic health records ehrs automated mailings stepped increases support improve crc screening adherence 2 years design 4group paralleldesign randomized controlled comparative effectiveness trial concealed allocation blinded outcome assessments clinicaltrialsgov nct00697047 setting 21 primary care medical centers patients 4675 adults aged 50 73 years current crc screening intervention usual care ehrlinked mailings automated automated plus telephone assistance assisted automated assisted plus nurse navigation testing completion refusal navigated interventions repeated year 2 measurements proportion participants current screening years defined colonoscopy sigmoidoscopy year 1 fecal occult blood testing fobt year 1 fobt colonoscopy sigmoidoscopy year 2 results compared usual care group participants intervention groups likely current crc screening years significant increases intensity usual care 263 95 ci 234 292 automated 508 ci 473 544 assisted 575 ci 545 606 navigated 647 ci 625 670 p 0001 pairwise comparisons increases screening primarily due increased uptake fobt completed years usual care 39 ci 28 51 automated 275 ci 249 300 assisted 305 ci 279 332 navigated 358 ci 331 386 limitation participants required provide verbal consent likely white participate types cancer screening limiting generalizability conclusion compared usual care centralized ehrlinked mailed crc screening program led twice many persons current screening 2 years assisted navigated interventions led smaller significant stepped increases compared automated intervention rapid growth ehrs provides opportunities spreading model broadly primary funding source national cancer institute national institutes health