Direct mail programs work… but

Direct mail programs work... but will health centers implement them? Findings from STOP CRC

Gloria D Coronado, PhD Beverly B Green, MD, MPH

? 2016, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH

Key Question

? How effective is a direct-mail fecal testing program when implemented in busy community clinic practices as part of standard care?

? To report the effectiveness and level of implementation of an electronic health record (EHR)? embedded program to directly mail fecal tests to patients due for colorectal cancer screening.

? 2016, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH

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Background

? The US Preventive Services Task Force recommends routine colorectal cancer screening for individuals aged 50 ? 75.

? Programs that directly mail fecal tests to patients' homes have been shown to improve rates of colorectal cancer screening in various clinical settings.

? Improvements have ranged from 6 ? 40%.

? Little is known about the effectiveness of such programs when implemented in community health centers as part of standard care.

? 2016, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH

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Previous direct-mail programs

Meta-Analysis of 11 studies

Test Offered Study

EventsI Total

Risk ratioand95%CI

Riskratio Mailed

Usual Care

Test

Study

Risk Ratio Sample size

FIT Singal 2S0i1n5gal 2015

1.98 21.4010 / 2400 335,559/ 19199

FIT Gupta 2G0u1p3ta2013

3.73 36.748 / 1593

457,149/ 31898

FIT Myers 2M01y3ers2013

1.19 1.1217 / 312

31250/ 38

FIT

FIT HendrenH2en0d1r3en2013

3.57 3.643 / 114

2214/0126

FIT Levy 20L1e3vy2013

4.48 4.1507 / 187

3337/2185

FIT Myers 2M01y7ers2007

l.63 1.1685 / 386

173573/ 387

FIT Total

2.10 22.5110 / 4992 11002,78/25833

FOBT Green 2G0r1e3en2013

2.46 27.560 / 1174 320,73/411167

FOBT Jean-JaJceqaune-Jsac2q0u1e2s2012 6.03 6.032 / 104

250/298

FOBT

FOBT HoffmanH2o0ff1m1an2011

2.61 2.698 / 202

539,138/ 36184

FOBT CoronadCoor2o0n1a1do2011 FOBT GoldberGgo2ld0b0e4rg2004 FOBT Total

14.40 8.14 3.26

14.44 / 168 8.124 / 59 39.358 / 1707

33/ 3165 131/960 960,938/ 41674

Marquez E, Singh S, Gupta S. Gastroenterology, Vol. 150, Issue 4, S450; DDW 2016

0.01 0.1

1

10

100

FavorsUsual Care FavorsIntervention

? 2016, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH

Success of direct-mail programs

Kaiser Permanente Northern California

Levin TR Gastrointest Endosc. 2016 Mar;83(3):552-4.

? Over 500,000 FITs mailed annually, with >60% returned ? Major contributor to achieving screening rate over 85%

? 2016, KAISER PERMANENTE CENTER FOR HEALTH RESEARCH

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