Kaiser Achieved Greater Than 80% Screening Adherence; How Did They Do It?
Douglas K. Rex, MD, MASGE, reviewing Selby K, et al. Clin Gastroenterol Hepatol 2020 Sep 30.
Organized screening, in which a nation or health care system systematically offers colorectal cancer screening for eligible patients, usually by fecal immunochemical testing (FIT), is widely considered to produce higher adherence rates than opportunistic screening. The latter is based on provider-patient interactions, usually in the office.
In the U.S., the Kaiser Permanente Northern California health system has the most developed and experienced organized screening program. This system has previously reported 82% adherence to screening, primarily with a mailed FIT program.
In this report, Kaiser physicians provide more detail on how they achieved 82% adherence. Among 1,023,415 eligible persons, 40% were up to date with screening, based on prior endoscopy. Another 20% responded to a mailed FIT offer within 28 days of mailing, another 6% after an automated call at week 4, and 4% after a mailed reminder letter at 6 weeks. There were 100,000 FIT kits ordered during direct-to-patient calls by medical assistants, and an additional 11% completed FIT outside of the automated invitations. Finally, 1.3% completed a colonoscopy, sigmoidoscopy, or fecal blood test unrelated to FIT.
COMMENTThis report indicates that the organized and automated FIT mailing was critical to achieving adherence of 80% but that an actual combination of efforts that included reminders after the mailing, personal contacts, and counting prior endoscopies was instrumental in achieving the 82% total adherence rate. The system also achieved an 84% colonoscopy rate in patients with positive FITs, which exceeds the quality target of 80% set by the U.S. Multi-Society Task Force on Colorectal Cancer. This level has not been reached or even been approached in many reports of FIT screening.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Selby K, Jensen CD, Levin TR, et al. Program components and results from an organized colorectal cancer screening program using annual fecal immunochemical testing. Clin Gastroenterol Hepatol 2020 Sep 30. (Epub ahead of print) (https://dx.doi.org/10.1016%2Fj.cgh.2020.09.042)
