Amit G. Singal|Jasmin A. Tiro|Caitlin C. Murphy|Jorge A. Marrero|Katharine McCallister|Hannah Fullington|Caroline Mejias|Akbar K. Waljee|Wendy Pechero Bishop|Noel Santini|Ethan A. Halm
Mailed Outreach Invitations Significantly Improve HCC Surveillance Rates in Patients With Cirrhosis: A Randomized Clinical Trial
The University of Texas Southwestern Medical Center|Parkland Health & Hospital System|The University of Texas Southwestern Medical Center|The University of Texas Southwestern Medical Center|The University of Texas Southwestern Medical Center|The University of Texas Southwestern Medical Center|The University of Texas Southwestern Medical Center|The University of Texas Southwestern Medical Center|University of Michigan–Ann Arbor|VA Center for Clinical Management Research|The University of Texas Southwestern Medical Center|The University of Texas Southwestern Medical Center|Parkland Health & Hospital System|The University of Texas Southwestern Medical Center|Parkland Health & Hospital System
hepatocellular carcinoma hcc surveillance associated early tumor detection improved survival patients cirrhosis however effectiveness limited underuse compared effectiveness mailed outreach patient navigation strategies increase hcc surveillance racially diverse cohort patients cirrhosis conducted pragmatic randomized clinical trial comparing mailed outreach screening ultrasound n 600 mailed outreach plus patient navigation n 600 usual care visitbased screening n 600 among 1800 patients cirrhosis large safetynet health system december 2014 march 2017 patients respond outreach invitations within 2 weeks received reminder telephone calls patient navigation included assessment barriers surveillance encouragement surveillance participation primary outcome hcc surveillance abdominal imaging every 6 months 18month period 1800 patients included intentiontoscreen analyses hcc surveillance performed 233 outreachnavigation patients 178 outreachalone patients 73 usual care patients hcc surveillance 160 95 confidence interval ci 120200 105 95 ci 68142 higher outreach groups usual care p lt 0001 55 95 ci 09101 higher outreachnavigation outreach alone p 002 interventions increased hcc surveillance across predefined patient subgroups proportion hcc patients detected early stage differ groups however higher proportion patients screendetected hcc across groups earlystage tumors hcc detected incidentally symptomatically 833 versus 308 p 0003 conclusion mailed outreach invitations navigation significantly increased hcc surveillance versus usual care patients cirrhosis