Effectiveness of a Patient and Practice-Level Colorectal Cancer Screening Intervention in Health Plan Members: The CHOICE Trial

Details

• Alternative Title:
  Cancer
• Personal Author:
  Pignone, Michael ; Winquist, Andrea ; Schild, Laura A. ; Lewis, Carmen ; Scott, Tracy ; Hawley, Jonathan ; Rimer, Barbara K. ; Glanz, Karen
• Description:
  Background
  
  Colorectal cancer (CRC) screening reduces CRC incidence and mortality but is underutilized. Effective interventions to increase screening that can be implemented broadly are needed.
  
  Methods
  
  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.
  
  Results
  
  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).
  
  Conclusions
  
  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.
  
  
• Subjects:
  Article Cancer Screening Colonic Neoplasms Colorectal Cancer Colorectal Neoplasms Decision Support Techniques Female Humans Insurance, Health Male Mass Screening Middle Aged Outcome Assessment, Health Care Primary Prevention

  More +
• Source:
  Cancer. 117(15):3352-3362
• Pubmed ID:
  21319147
• Pubmed Central ID:
  PMC3136553
• Document Type:
  Journal Article
• 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
• Volume:
  117
• Issue:
  15
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:aa29f8fca229bb88bbbe5999d92bee7ef7d8bc0ee97a6cd1d3f594a31d77acf9
• Download URL:
  https://stacks.cdc.gov/view/cdc/33224/cdc_33224_DS1.pdf
• File Type:
  [PDF - 737.70 KB ]