Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial
Background Colorectal cancer (CRC) screening is effective but underused. Screening rates are lower among Medicaid beneficiaries versus other insured populations. No studies have examined mailed fecal immunochemical testing (FIT)–based outreach programs for Medicaid beneficiaries. Methods In a patien...
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| Veröffentlicht in: | Cancer 2018-08, Vol.124 (16), p.3346-3354 |
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| creator | Brenner, Alison T. Rhode, Jewels Yang, Jeff Y. Baker, Dana Drechsel, Rebecca Plescia, Marcus Reuland, Daniel S. Wroth, Tom Wheeler, Stephanie B. |
| description | Background
Colorectal cancer (CRC) screening is effective but underused. Screening rates are lower among Medicaid beneficiaries versus other insured populations. No studies have examined mailed fecal immunochemical testing (FIT)–based outreach programs for Medicaid beneficiaries.
Methods
In a patient‐level randomized controlled trial, a mailed CRC screening reminder plus FIT, sent from an urban health department to Medicaid beneficiaries, was compared with the same reminder without FIT. The reminder group could request FIT. Completed FIT kits were processed by the health department laboratory. Respondents were notified of normal results by mail. Abnormal results were given via phone by a patient navigator who provided counselling and assistance with follow‐up care. The primary outcome was FIT return.
Results
In all, 2144 beneficiaries at average CRC risk were identified, and there was no evidence of screening with Medicaid claims data. To the reminder+FIT group, 1071 were randomized, and 1073 were randomized to the reminder group; 307 (28.7%) in the reminder+FIT group and 347 (32.3%) in the reminder group were unreachable or ineligible (previous screening). The FIT return rate was significantly higher in the reminder+FIT group than the reminder group (21.1% vs 12.3%; difference, 8.8%; 95% confidence interval, 3.7%‐13.9%; P |
| doi_str_mv | 10.1002/cncr.31566 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6446899</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2092506739</sourcerecordid><originalsourceid>FETCH-LOGICAL-p3366-54029e678af696f7f43ea747bdb173cc13594513b272726b09473c6d30e12cc33</originalsourceid><addsrcrecordid>eNpdUsFu1DAQtRCIbgsXPgBZ4sJlix0n9oYDUhVBQSogIZC4WY4z6bpy7MV2Wi0_xu8x2ZYKkA9-M_P8_MYeQp5xdsoZq17ZYNOp4I2UD8iKs1atGa-rh2TFGNusm1p8PyLHOV9hqKpGPCZHAmHdKLUiv7o47UwyxV0DhXEEu6AAOdM40sk4DwNNMLkwQMr0xpUtNWE4gDgXigeMp26a5hDtFnlLWCCXTMeY6EcYMOMG2qPm6KwzyUGmplBDvUmXQG2cQ9nTLRiP0gOgmTJBKK_pGU14U5zcT7RgYygp-sVNSc74J-TRaHyGp3f7Cfn27u3X7v364vP5h-7sYr0TQkpsnlUtSLUxo2zlqMZagFG16oeeK2EtF01bN1z0lcIle9bWmJaDYMAra4U4IW9udXdzP8Fg0VkyXu-Sm0za62ic_rcS3FZfxmst61pu2hYFXt4JpPhjxofRk8sWvDcB4px1xRSrhGQbidQX_1Gv4pwCtoestmqYVGIRfP63o3srf_4UCfyWcIOft7-vc6aXadHLtOjDtOjuU_flgMRvcbO23g</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2092506739</pqid></control><display><type>article</type><title>Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Wiley Free Content</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Brenner, Alison T. ; Rhode, Jewels ; Yang, Jeff Y. ; Baker, Dana ; Drechsel, Rebecca ; Plescia, Marcus ; Reuland, Daniel S. ; Wroth, Tom ; Wheeler, Stephanie B.</creator><creatorcontrib>Brenner, Alison T. ; Rhode, Jewels ; Yang, Jeff Y. ; Baker, Dana ; Drechsel, Rebecca ; Plescia, Marcus ; Reuland, Daniel S. ; Wroth, Tom ; Wheeler, Stephanie B.</creatorcontrib><description>Background
Colorectal cancer (CRC) screening is effective but underused. Screening rates are lower among Medicaid beneficiaries versus other insured populations. No studies have examined mailed fecal immunochemical testing (FIT)–based outreach programs for Medicaid beneficiaries.
Methods
In a patient‐level randomized controlled trial, a mailed CRC screening reminder plus FIT, sent from an urban health department to Medicaid beneficiaries, was compared with the same reminder without FIT. The reminder group could request FIT. Completed FIT kits were processed by the health department laboratory. Respondents were notified of normal results by mail. Abnormal results were given via phone by a patient navigator who provided counselling and assistance with follow‐up care. The primary outcome was FIT return.
Results
In all, 2144 beneficiaries at average CRC risk were identified, and there was no evidence of screening with Medicaid claims data. To the reminder+FIT group, 1071 were randomized, and 1073 were randomized to the reminder group; 307 (28.7%) in the reminder+FIT group and 347 (32.3%) in the reminder group were unreachable or ineligible (previous screening). The FIT return rate was significantly higher in the reminder+FIT group than the reminder group (21.1% vs 12.3%; difference, 8.8%; 95% confidence interval, 3.7%‐13.9%; P < .01). Eighteen individuals (7.2%) who completed FIT tests had abnormal results, and 15 were eligible for follow‐up colonoscopy; 66.7% (n = 10) completed follow‐up colonoscopy.
Conclusions
A health department–based, mailed FIT program targeting Medicaid beneficiaries was feasible. Including a FIT kit resulted in greater screening completion than a reminder letter alone. Further research is needed to understand the comparative cost‐effectiveness of these interventions.
A feasible patient‐level randomized controlled trial has been conducted to compare a mailed colorectal cancer screening reminder plus a fecal immunochemical testing kit from an urban health department with the same reminder without the kit. The results indicate that including a fecal immunochemical testing kit results in greater screening completion than a reminder letter alone.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.31566</identifier><identifier>PMID: 30004577</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; cancer prevention ; Clinical trials ; Colon ; Colonoscopy ; Colorectal cancer ; colorectal cancer screening ; Colorectal carcinoma ; Colorectal Neoplasms - diagnosis ; Colorectal Neoplasms - economics ; Colorectal Neoplasms - epidemiology ; Colorectal Neoplasms - pathology ; Confidence intervals ; Early Detection of Cancer ; fecal immunochemical testing ; Feces ; Female ; Government programs ; Health ; Health care ; Humans ; Immunochemistry - methods ; Male ; Medicaid ; Medicaid beneficiaries ; Middle Aged ; Oncology ; Outreach programs ; Population studies ; Postal Service ; Randomization ; randomized control trial (RCT) ; Screening ; United States</subject><ispartof>Cancer, 2018-08, Vol.124 (16), p.3346-3354</ispartof><rights>2018 American Cancer Society</rights><rights>2018 American Cancer Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0001-6421-9982</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.31566$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.31566$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1416,1432,27922,27923,45572,45573,46407,46831</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30004577$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brenner, Alison T.</creatorcontrib><creatorcontrib>Rhode, Jewels</creatorcontrib><creatorcontrib>Yang, Jeff Y.</creatorcontrib><creatorcontrib>Baker, Dana</creatorcontrib><creatorcontrib>Drechsel, Rebecca</creatorcontrib><creatorcontrib>Plescia, Marcus</creatorcontrib><creatorcontrib>Reuland, Daniel S.</creatorcontrib><creatorcontrib>Wroth, Tom</creatorcontrib><creatorcontrib>Wheeler, Stephanie B.</creatorcontrib><title>Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial</title><title>Cancer</title><addtitle>Cancer</addtitle><description>Background
Colorectal cancer (CRC) screening is effective but underused. Screening rates are lower among Medicaid beneficiaries versus other insured populations. No studies have examined mailed fecal immunochemical testing (FIT)–based outreach programs for Medicaid beneficiaries.
Methods
In a patient‐level randomized controlled trial, a mailed CRC screening reminder plus FIT, sent from an urban health department to Medicaid beneficiaries, was compared with the same reminder without FIT. The reminder group could request FIT. Completed FIT kits were processed by the health department laboratory. Respondents were notified of normal results by mail. Abnormal results were given via phone by a patient navigator who provided counselling and assistance with follow‐up care. The primary outcome was FIT return.
Results
In all, 2144 beneficiaries at average CRC risk were identified, and there was no evidence of screening with Medicaid claims data. To the reminder+FIT group, 1071 were randomized, and 1073 were randomized to the reminder group; 307 (28.7%) in the reminder+FIT group and 347 (32.3%) in the reminder group were unreachable or ineligible (previous screening). The FIT return rate was significantly higher in the reminder+FIT group than the reminder group (21.1% vs 12.3%; difference, 8.8%; 95% confidence interval, 3.7%‐13.9%; P < .01). Eighteen individuals (7.2%) who completed FIT tests had abnormal results, and 15 were eligible for follow‐up colonoscopy; 66.7% (n = 10) completed follow‐up colonoscopy.
Conclusions
A health department–based, mailed FIT program targeting Medicaid beneficiaries was feasible. Including a FIT kit resulted in greater screening completion than a reminder letter alone. Further research is needed to understand the comparative cost‐effectiveness of these interventions.
A feasible patient‐level randomized controlled trial has been conducted to compare a mailed colorectal cancer screening reminder plus a fecal immunochemical testing kit from an urban health department with the same reminder without the kit. The results indicate that including a fecal immunochemical testing kit results in greater screening completion than a reminder letter alone.</description><subject>Aged</subject><subject>cancer prevention</subject><subject>Clinical trials</subject><subject>Colon</subject><subject>Colonoscopy</subject><subject>Colorectal cancer</subject><subject>colorectal cancer screening</subject><subject>Colorectal carcinoma</subject><subject>Colorectal Neoplasms - diagnosis</subject><subject>Colorectal Neoplasms - economics</subject><subject>Colorectal Neoplasms - epidemiology</subject><subject>Colorectal Neoplasms - pathology</subject><subject>Confidence intervals</subject><subject>Early Detection of Cancer</subject><subject>fecal immunochemical testing</subject><subject>Feces</subject><subject>Female</subject><subject>Government programs</subject><subject>Health</subject><subject>Health care</subject><subject>Humans</subject><subject>Immunochemistry - methods</subject><subject>Male</subject><subject>Medicaid</subject><subject>Medicaid beneficiaries</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Outreach programs</subject><subject>Population studies</subject><subject>Postal Service</subject><subject>Randomization</subject><subject>randomized control trial (RCT)</subject><subject>Screening</subject><subject>United States</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUsFu1DAQtRCIbgsXPgBZ4sJlix0n9oYDUhVBQSogIZC4WY4z6bpy7MV2Wi0_xu8x2ZYKkA9-M_P8_MYeQp5xdsoZq17ZYNOp4I2UD8iKs1atGa-rh2TFGNusm1p8PyLHOV9hqKpGPCZHAmHdKLUiv7o47UwyxV0DhXEEu6AAOdM40sk4DwNNMLkwQMr0xpUtNWE4gDgXigeMp26a5hDtFnlLWCCXTMeY6EcYMOMG2qPm6KwzyUGmplBDvUmXQG2cQ9nTLRiP0gOgmTJBKK_pGU14U5zcT7RgYygp-sVNSc74J-TRaHyGp3f7Cfn27u3X7v364vP5h-7sYr0TQkpsnlUtSLUxo2zlqMZagFG16oeeK2EtF01bN1z0lcIle9bWmJaDYMAra4U4IW9udXdzP8Fg0VkyXu-Sm0za62ic_rcS3FZfxmst61pu2hYFXt4JpPhjxofRk8sWvDcB4px1xRSrhGQbidQX_1Gv4pwCtoestmqYVGIRfP63o3srf_4UCfyWcIOft7-vc6aXadHLtOjDtOjuU_flgMRvcbO23g</recordid><startdate>20180801</startdate><enddate>20180801</enddate><creator>Brenner, Alison T.</creator><creator>Rhode, Jewels</creator><creator>Yang, Jeff Y.</creator><creator>Baker, Dana</creator><creator>Drechsel, Rebecca</creator><creator>Plescia, Marcus</creator><creator>Reuland, Daniel S.</creator><creator>Wroth, Tom</creator><creator>Wheeler, Stephanie B.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7TO</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6421-9982</orcidid></search><sort><creationdate>20180801</creationdate><title>Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial</title><author>Brenner, Alison T. ; Rhode, Jewels ; Yang, Jeff Y. ; Baker, Dana ; Drechsel, Rebecca ; Plescia, Marcus ; Reuland, Daniel S. ; Wroth, Tom ; Wheeler, Stephanie B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p3366-54029e678af696f7f43ea747bdb173cc13594513b272726b09473c6d30e12cc33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>cancer prevention</topic><topic>Clinical trials</topic><topic>Colon</topic><topic>Colonoscopy</topic><topic>Colorectal cancer</topic><topic>colorectal cancer screening</topic><topic>Colorectal carcinoma</topic><topic>Colorectal Neoplasms - diagnosis</topic><topic>Colorectal Neoplasms - economics</topic><topic>Colorectal Neoplasms - epidemiology</topic><topic>Colorectal Neoplasms - pathology</topic><topic>Confidence intervals</topic><topic>Early Detection of Cancer</topic><topic>fecal immunochemical testing</topic><topic>Feces</topic><topic>Female</topic><topic>Government programs</topic><topic>Health</topic><topic>Health care</topic><topic>Humans</topic><topic>Immunochemistry - methods</topic><topic>Male</topic><topic>Medicaid</topic><topic>Medicaid beneficiaries</topic><topic>Middle Aged</topic><topic>Oncology</topic><topic>Outreach programs</topic><topic>Population studies</topic><topic>Postal Service</topic><topic>Randomization</topic><topic>randomized control trial (RCT)</topic><topic>Screening</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brenner, Alison T.</creatorcontrib><creatorcontrib>Rhode, Jewels</creatorcontrib><creatorcontrib>Yang, Jeff Y.</creatorcontrib><creatorcontrib>Baker, Dana</creatorcontrib><creatorcontrib>Drechsel, Rebecca</creatorcontrib><creatorcontrib>Plescia, Marcus</creatorcontrib><creatorcontrib>Reuland, Daniel S.</creatorcontrib><creatorcontrib>Wroth, Tom</creatorcontrib><creatorcontrib>Wheeler, Stephanie B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brenner, Alison T.</au><au>Rhode, Jewels</au><au>Yang, Jeff Y.</au><au>Baker, Dana</au><au>Drechsel, Rebecca</au><au>Plescia, Marcus</au><au>Reuland, Daniel S.</au><au>Wroth, Tom</au><au>Wheeler, Stephanie B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2018-08-01</date><risdate>2018</risdate><volume>124</volume><issue>16</issue><spage>3346</spage><epage>3354</epage><pages>3346-3354</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><abstract>Background
Colorectal cancer (CRC) screening is effective but underused. Screening rates are lower among Medicaid beneficiaries versus other insured populations. No studies have examined mailed fecal immunochemical testing (FIT)–based outreach programs for Medicaid beneficiaries.
Methods
In a patient‐level randomized controlled trial, a mailed CRC screening reminder plus FIT, sent from an urban health department to Medicaid beneficiaries, was compared with the same reminder without FIT. The reminder group could request FIT. Completed FIT kits were processed by the health department laboratory. Respondents were notified of normal results by mail. Abnormal results were given via phone by a patient navigator who provided counselling and assistance with follow‐up care. The primary outcome was FIT return.
Results
In all, 2144 beneficiaries at average CRC risk were identified, and there was no evidence of screening with Medicaid claims data. To the reminder+FIT group, 1071 were randomized, and 1073 were randomized to the reminder group; 307 (28.7%) in the reminder+FIT group and 347 (32.3%) in the reminder group were unreachable or ineligible (previous screening). The FIT return rate was significantly higher in the reminder+FIT group than the reminder group (21.1% vs 12.3%; difference, 8.8%; 95% confidence interval, 3.7%‐13.9%; P < .01). Eighteen individuals (7.2%) who completed FIT tests had abnormal results, and 15 were eligible for follow‐up colonoscopy; 66.7% (n = 10) completed follow‐up colonoscopy.
Conclusions
A health department–based, mailed FIT program targeting Medicaid beneficiaries was feasible. Including a FIT kit resulted in greater screening completion than a reminder letter alone. Further research is needed to understand the comparative cost‐effectiveness of these interventions.
A feasible patient‐level randomized controlled trial has been conducted to compare a mailed colorectal cancer screening reminder plus a fecal immunochemical testing kit from an urban health department with the same reminder without the kit. The results indicate that including a fecal immunochemical testing kit results in greater screening completion than a reminder letter alone.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30004577</pmid><doi>10.1002/cncr.31566</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-6421-9982</orcidid></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Wiley Free Content; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged cancer prevention Clinical trials Colon Colonoscopy Colorectal cancer colorectal cancer screening Colorectal carcinoma Colorectal Neoplasms - diagnosis Colorectal Neoplasms - economics Colorectal Neoplasms - epidemiology Colorectal Neoplasms - pathology Confidence intervals Early Detection of Cancer fecal immunochemical testing Feces Female Government programs Health Health care Humans Immunochemistry - methods Male Medicaid Medicaid beneficiaries Middle Aged Oncology Outreach programs Population studies Postal Service Randomization randomized control trial (RCT) Screening United States |
| title | Comparative effectiveness of mailed reminders with and without fecal immunochemical tests for Medicaid beneficiaries at a large county health department: A randomized controlled trial |
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