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Effect of Patient Portal Messaging Before Mailing Fecal Immunochemical Test Kit on Colorectal Cancer Screening Rates: A Randomized Clinical Trial

IMPORTANCE: Colorectal cancer (CRC) screening reduces CRC mortality; however, screening rates remain well below the national benchmark of 80%. OBJECTIVE: To determine whether an electronic primer message delivered through the patient portal increases the completion rate of CRC screening in a mailed...

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Autores principales: Goshgarian, Gregory, Sorourdi, Camille, May, Folasade P., Vangala, Sitaram, Meshkat, Sarah, Roh, Lily, Han, Maria A., Croymans, Daniel M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8817202/
https://www.ncbi.nlm.nih.gov/pubmed/35119462
http://dx.doi.org/10.1001/jamanetworkopen.2021.46863
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author Goshgarian, Gregory
Sorourdi, Camille
May, Folasade P.
Vangala, Sitaram
Meshkat, Sarah
Roh, Lily
Han, Maria A.
Croymans, Daniel M.
author_facet Goshgarian, Gregory
Sorourdi, Camille
May, Folasade P.
Vangala, Sitaram
Meshkat, Sarah
Roh, Lily
Han, Maria A.
Croymans, Daniel M.
author_sort Goshgarian, Gregory
collection PubMed
description IMPORTANCE: Colorectal cancer (CRC) screening reduces CRC mortality; however, screening rates remain well below the national benchmark of 80%. OBJECTIVE: To determine whether an electronic primer message delivered through the patient portal increases the completion rate of CRC screening in a mailed fecal immunochemical test (FIT) outreach program. DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical quality improvement trial at the University of California, Los Angeles Health of 2339 patients enrolled in a FIT mailing program from August 28, 2019, to September 20, 2020, patients were randomly assigned to either the control or intervention group, and the screening completion rate was measured at 6 months. Participants were average-risk managed care patients aged 50 to 75 years, with a valid mailing address, no mailed CRC outreach in the previous 6 months, and an active electronic health record (EHR) patient portal who were due for CRC screening. Data were analyzed on an intention-to-treat basis. INTERVENTIONS: Eligible patients were randomly assigned to receive either (1) the standard FIT mailed outreach (control group) or (2) the standard FIT mailed outreach plus an automated primer to notify patients of the upcoming mailed FIT sent through the electronic patient portal (intervention group). MAIN OUTCOMES AND MEASURES: The primary outcome was the screening completion rate (ie, returning the FIT). Secondary outcomes were (1) were the time to CRC screening from the FIT mailing date, (2) screening modality completed, and (3) the effect of opening the electronic primer on screening completion rate. RESULTS: The study included 2339 patients (1346 women [57.5%]; mean [SD] age, 58.9 [7.5] years). The screening completion rate was higher in the intervention group than in the control group (37.6% [445 of 1182] vs 32.1% [371 of 1157]; P = .005). The time to screening was shorter in the intervention group than in the control group (adjusted hazard ratio, 1.24; 95% CI, 1.08-1.42; P = .003). The proportion of each screening test modality completed was similar in both groups. In a subanalysis of the 900 of 1182 patients (76.1%) in the intervention group who opened the patient portal primer message, there was a 7.3–percentage point (95% CI, 2.3-12.4 percentage points) increase in CRC screening (local mean treatment effect; P = .004). CONCLUSIONS AND RELEVANCE: Implementation of an electronic patient portal primer message in a mailed FIT outreach program led to a significant increase in CRC screening and improvement in the time to screening completion. The findings provide an evidence base for additional refinements to mailed FIT outreach quality improvement programs in large health systems. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05115916
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spelling pubmed-88172022022-02-16 Effect of Patient Portal Messaging Before Mailing Fecal Immunochemical Test Kit on Colorectal Cancer Screening Rates: A Randomized Clinical Trial Goshgarian, Gregory Sorourdi, Camille May, Folasade P. Vangala, Sitaram Meshkat, Sarah Roh, Lily Han, Maria A. Croymans, Daniel M. JAMA Netw Open Original Investigation IMPORTANCE: Colorectal cancer (CRC) screening reduces CRC mortality; however, screening rates remain well below the national benchmark of 80%. OBJECTIVE: To determine whether an electronic primer message delivered through the patient portal increases the completion rate of CRC screening in a mailed fecal immunochemical test (FIT) outreach program. DESIGN, SETTING, AND PARTICIPANTS: In this randomized clinical quality improvement trial at the University of California, Los Angeles Health of 2339 patients enrolled in a FIT mailing program from August 28, 2019, to September 20, 2020, patients were randomly assigned to either the control or intervention group, and the screening completion rate was measured at 6 months. Participants were average-risk managed care patients aged 50 to 75 years, with a valid mailing address, no mailed CRC outreach in the previous 6 months, and an active electronic health record (EHR) patient portal who were due for CRC screening. Data were analyzed on an intention-to-treat basis. INTERVENTIONS: Eligible patients were randomly assigned to receive either (1) the standard FIT mailed outreach (control group) or (2) the standard FIT mailed outreach plus an automated primer to notify patients of the upcoming mailed FIT sent through the electronic patient portal (intervention group). MAIN OUTCOMES AND MEASURES: The primary outcome was the screening completion rate (ie, returning the FIT). Secondary outcomes were (1) were the time to CRC screening from the FIT mailing date, (2) screening modality completed, and (3) the effect of opening the electronic primer on screening completion rate. RESULTS: The study included 2339 patients (1346 women [57.5%]; mean [SD] age, 58.9 [7.5] years). The screening completion rate was higher in the intervention group than in the control group (37.6% [445 of 1182] vs 32.1% [371 of 1157]; P = .005). The time to screening was shorter in the intervention group than in the control group (adjusted hazard ratio, 1.24; 95% CI, 1.08-1.42; P = .003). The proportion of each screening test modality completed was similar in both groups. In a subanalysis of the 900 of 1182 patients (76.1%) in the intervention group who opened the patient portal primer message, there was a 7.3–percentage point (95% CI, 2.3-12.4 percentage points) increase in CRC screening (local mean treatment effect; P = .004). CONCLUSIONS AND RELEVANCE: Implementation of an electronic patient portal primer message in a mailed FIT outreach program led to a significant increase in CRC screening and improvement in the time to screening completion. The findings provide an evidence base for additional refinements to mailed FIT outreach quality improvement programs in large health systems. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05115916 American Medical Association 2022-02-04 /pmc/articles/PMC8817202/ /pubmed/35119462 http://dx.doi.org/10.1001/jamanetworkopen.2021.46863 Text en Copyright 2022 Goshgarian G et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Goshgarian, Gregory
Sorourdi, Camille
May, Folasade P.
Vangala, Sitaram
Meshkat, Sarah
Roh, Lily
Han, Maria A.
Croymans, Daniel M.
Effect of Patient Portal Messaging Before Mailing Fecal Immunochemical Test Kit on Colorectal Cancer Screening Rates: A Randomized Clinical Trial
title Effect of Patient Portal Messaging Before Mailing Fecal Immunochemical Test Kit on Colorectal Cancer Screening Rates: A Randomized Clinical Trial
title_full Effect of Patient Portal Messaging Before Mailing Fecal Immunochemical Test Kit on Colorectal Cancer Screening Rates: A Randomized Clinical Trial
title_fullStr Effect of Patient Portal Messaging Before Mailing Fecal Immunochemical Test Kit on Colorectal Cancer Screening Rates: A Randomized Clinical Trial
title_full_unstemmed Effect of Patient Portal Messaging Before Mailing Fecal Immunochemical Test Kit on Colorectal Cancer Screening Rates: A Randomized Clinical Trial
title_short Effect of Patient Portal Messaging Before Mailing Fecal Immunochemical Test Kit on Colorectal Cancer Screening Rates: A Randomized Clinical Trial
title_sort effect of patient portal messaging before mailing fecal immunochemical test kit on colorectal cancer screening rates: a randomized clinical trial
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8817202/
https://www.ncbi.nlm.nih.gov/pubmed/35119462
http://dx.doi.org/10.1001/jamanetworkopen.2021.46863
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