Amit G. Singal|Jasmin A. Tiro|Jorge A. Marrero|Katharine McCallister|Caroline Mejias|Brian Adamson|Wendy Pechero Bishop|Noel Santini|Ethan A. Halm
Mailed Outreach Program Increases Ultrasound Screening of Patients With Cirrhosis for Hepatocellular Carcinoma
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|The University of Texas Southwestern Medical Center|Parkland Health & Hospital System|Parkland Health & Hospital System|The University of Texas Southwestern Medical Center
surveillance patients cirrhosis increases early detection hepatocellular carcinoma hcc prolongs survival however effectiveness limited underuse particularly among racialethnic minorities individuals low socioeconomic status compared effectiveness mailed outreach strategies without patient navigation increasing numbers patients cirrhosis undergoing surveillance hcc racially diverse socioeconomically disadvantaged cohortwe performed prospective study patients documented suspected cirrhosis large safetynet health system december 2014 march 2016 patients assigned randomly 111 groups received mailed invitations ultrasound screening examination n 600 mailed invitations ultrasound screening examination patient navigation barrier assessment motivational education patients declined screening n 600 usual care visitbased screening n 600 patients respond outreach invitations within 2 weeks received 3 reminder telephone calls primary outcome completion abdominal imaging within 6 months randomizationbaseline characteristics similar among groups cirrhosis documented based international classification diseases 9th revision codes 796 patients suspected based noninvasive markers fibrosis 204 intenttotreat analysis significantly greater proportions patients received mailed invitation navigation 472 mailed invitation alone 445 underwent hcc screening patients received usual care 243 p 001 comparisons however screening rates differ significantly outreach outreach groups p 25 effects outreach program consistent subgroups including caucasian vs noncaucasian race documented vs suspected cirrhosis childpugh vs b cirrhosis receipt gastroenterology carein prospective study found outreach strategies double percentage patients cirrhosis underwent ultrasound screening hcc however adding patient navigation telephone reminders provided significant additional benefit clinicaltrialsgov nct02312817