Effectiveness of a Patient and Practice-Level Colorectal Cancer Screening Intervention in Health Plan Members: The CHOICE Trial
Published Date:Feb 11 2011
Pubmed Central ID:PMC3136553
Funding:R01 PH000018/PH/PHPPO CDC HHS/United States
PH000018/PH/PHPPO CDC HHS/United States
K05 CA129166-01A1/CA/NCI NIH HHS/United States
5K07CA104128/CA/NCI NIH HHS/United States
K07 CA104128-05/CA/NCI NIH HHS/United States
K07 CA104128-03/CA/NCI NIH HHS/United States
K07 CA104128/CA/NCI NIH HHS/United States
K05 CA129166/CA/NCI NIH HHS/United States
K07 CA104128-04/CA/NCI NIH HHS/United States
Colorectal cancer (CRC) screening reduces CRC incidence and mortality but is underutilized. Effective interventions to increase screening that can be implemented broadly are needed.
We conducted a controlled trial to evaluate patient and practice-level intervention to increase use of recommended CRC screening tests among health plan members. The patient-level intervention was a patient decision aid and stage-targeted brochures, mailed to health plan members. Intervention practices received academic detailing to prepare practices to facilitate CRC testing once patients were activated by the decision aid. We used patient surveys and claims data to assess CRC screening test completion.
Among 443 active participants, 75.8% were 52–59 years of age, 80.9% were White, 62.1% were women and 46.4% had college degrees or greater education. Among 380 active participants with known screening status at 12 months based on survey results, 39.0% in the intervention group reported receiving CRC screening compared with 32.2% in the usual care group (unadjusted odds ratio (OR) 1.34, 95% CI 0.88, 2.05, p=0.17). After adjusting for baseline differences and accounting for clustering, the effect was somewhat larger (OR 1.64, 95% CI 0.98, 2.73, p=0.06). Claims analysis produced similar effects for active participants. Intervention was more effective in those with income over $50,000 (OR 2.16, 95% CI 1.07, 4.35) than those with lower income (OR 1.25, 95% CI 0.53, 2.94, p = 0.03 for interaction).
An intervention combining a patient-directed decision aid and practice-directed academic detailing had a modest, though non-statistically significant, effect on colon cancer screening rates among active participants.
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