结直肠癌(CRC)筛查可降低CRC死亡率;筛查率仍远低于80%的国家基准。
在邮寄粪便免疫化学测试(FIT)外展计划中,确定通过患者门户传递的电子引物信息是否提高了CRC筛查的完成率。
在加州大学的这项随机临床质量改进试验中,洛杉矶健康从2019年8月28日至2020年9月20日在FIT邮件计划中招募了2339名患者,患者被随机分配到对照组或干预组。并在6个月时测量筛查完成率。参与者是年龄在50至75岁之间的平均风险管理护理患者,使用有效的邮寄地址,在过去6个月没有邮寄CRC外展,和应进行CRC筛查的主动电子健康记录(EHR)患者门户。在意向治疗的基础上分析数据。
符合条件的患者被随机分配接受(1)标准FIT邮寄外展(对照组)或(2)标准FIT邮寄外展以及自动入门,以通知患者即将通过电子患者门户发送的FIT(干预组)。
主要结局是筛查完成率(即,返回FIT)。次要结果是(1)从FIT邮寄日期开始进行CRC筛查的时间,(2)筛选方式完成,(3)电子引物开放对筛选完成率的影响。
该研究包括2339名患者(1346名女性[57.5%];平均[SD]年龄,58.9[7.5]年)。干预组的筛查完成率高于对照组(37.6%[1182的445]vs32.1%[1157的371];P=.005)。干预组的筛查时间短于对照组(调整后的风险比,1.24;95%CI,1.08-1.42;P=.003)。两组中完成的每种筛查测试方式的比例相似。在对干预组中打开患者门户入门信息的1182名患者中的900名(76.1%)的亚分析中,CRC筛查增加7.3个百分点(95%CI,2.3-12.4个百分点)(局部平均治疗效果;P=.004).
在邮寄FIT外展计划中实施电子患者门户入门信息导致CRC筛查的显着增加和筛查完成时间的改善。这些发现为在大型卫生系统中邮寄FIT外展质量改进计划的其他改进提供了证据基础。
ClinicalTrials.gov标识符:NCT05115916。
Colorectal cancer (CRC) screening reduces CRC mortality; however, screening rates remain well below the national benchmark of 80%.
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.
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.
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).
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.
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).
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.
ClinicalTrials.gov Identifier: NCT05115916.