Jennifer S Haas1, Steven J Atlas2, Adam Wright3, E John Orav4, David G Aman5, Erica S Breslau6, Timothy E Burdick7, Emily Carpenter2, Frank Chang4, Tin Dang2, Courtney J Diamond2, Sarah Feldman8, Kimberly A Harris2, Shoshana J Hort9, Molly L Housman10, Amrita Mecker2, Constance D Lehman11, Sanja Percac-Lima2, Rebecca Smith10, Amy J Wint2, Jie Yang4, Li Zhou4, Anna N A Tosteson12. 1. Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: Jennifer.Haas@mgh.harvard.edu. 2. Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 3. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA. 4. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA. 5. Information, Technology and Consulting (ITC), Dartmouth College, Lebanon, NH. 6. Division of Cancer Prevention and Control, National Cancer Institute, Rockville, MD, USA. 7. Department of Community and Family Medicine, Dartmouth-Hitchcock Health, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, NH, USA. 8. Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA. 9. Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, NH, USA. 10. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, NH, USA. 11. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 12. The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Hanover, NH, USA; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
Abstract
INTRODUCTION: While substantial attention is focused on the delivery of routine preventive cancer screening, less attention has been paid to systematically ensuring that there is timely follow-up of abnormal screening test results. Barriers to completion of timely follow-up occur at the patient, provider, care team and system levels. METHODS: In this pragmatic cluster randomized controlled trial, primary care sites in three networks are randomized to one of four arms: (1) standard care, (2) "visit-based" reminders that appear in a patient's electronic health record (EHR) when it is accessed by either patient or providers (3) visit based reminders with population health outreach, and (4) visit based reminders, population health outreach, and patient navigation with systematic screening and referral to address social barriers to care. Eligible patients in participating practices are those overdue for follow-up of an abnormal results on breast, cervical, colorectal and lung cancer screening tests. RESULTS: The primary outcome is whether an individual receives follow-up, specific to the organ type and screening abnormality, within 120 days of becoming eligible for the trial. Secondary outcomes assess the effect of intervention components on the patient and provider experience of obtaining follow-up care and the delivery of the intervention components. CONCLUSIONS: This trial will provide evidence for the role of a multilevel intervention on improving the follow-up of abnormal cancer screening test results. We will also specifically assess the relative impact of the components of the intervention, compared to standard care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03979495.
INTRODUCTION: While substantial attention is focused on the delivery of routine preventive cancer screening, less attention has been paid to systematically ensuring that there is timely follow-up of abnormal screening test results. Barriers to completion of timely follow-up occur at the patient, provider, care team and system levels. METHODS: In this pragmatic cluster randomized controlled trial, primary care sites in three networks are randomized to one of four arms: (1) standard care, (2) "visit-based" reminders that appear in a patient's electronic health record (EHR) when it is accessed by either patient or providers (3) visit based reminders with population health outreach, and (4) visit based reminders, population health outreach, and patient navigation with systematic screening and referral to address social barriers to care. Eligible patients in participating practices are those overdue for follow-up of an abnormal results on breast, cervical, colorectal and lung cancer screening tests. RESULTS: The primary outcome is whether an individual receives follow-up, specific to the organ type and screening abnormality, within 120 days of becoming eligible for the trial. Secondary outcomes assess the effect of intervention components on the patient and provider experience of obtaining follow-up care and the delivery of the intervention components. CONCLUSIONS: This trial will provide evidence for the role of a multilevel intervention on improving the follow-up of abnormal cancer screening test results. We will also specifically assess the relative impact of the components of the intervention, compared to standard care. TRIAL REGISTRATION: ClinicalTrials.gov NCT03979495.
Authors: Denise R Aberle; Amanda M Adams; Christine D Berg; William C Black; Jonathan D Clapp; Richard M Fagerstrom; Ilana F Gareen; Constantine Gatsonis; Pamela M Marcus; JoRean D Sicks Journal: N Engl J Med Date: 2011-06-29 Impact factor: 91.245
Authors: Elisabeth F Beaber; Jane J Kim; Marilyn M Schapira; Anna N A Tosteson; Ann G Zauber; Ann M Geiger; Aruna Kamineni; Donald L Weaver; Jasmin A Tiro Journal: J Natl Cancer Inst Date: 2015-05-07 Impact factor: 13.506
Authors: K Robin Yabroff; Kathleen Shakira Washington; Amy Leader; Elizabeth Neilson; Jeanne Mandelblatt Journal: Med Care Res Rev Date: 2003-09 Impact factor: 3.929
Authors: Rebecca B Perkins; Richard S Guido; Philip E Castle; David Chelmow; Mark H Einstein; Francisco Garcia; Warner K Huh; Jane J Kim; Anna-Barbara Moscicki; Ritu Nayar; Mona Saraiya; George F Sawaya; Nicolas Wentzensen; Mark Schiffman Journal: J Low Genit Tract Dis Date: 2020-04 Impact factor: 1.925
Authors: Susan J Curry; Alex H Krist; Douglas K Owens; Michael J Barry; Aaron B Caughey; Karina W Davidson; Chyke A Doubeni; John W Epling; Alex R Kemper; Martha Kubik; C Seth Landefeld; Carol M Mangione; Maureen G Phipps; Michael Silverstein; Melissa A Simon; Chien-Wen Tseng; John B Wong Journal: JAMA Date: 2018-08-21 Impact factor: 56.272
Authors: Douglas A Corley; Christopher D Jensen; Amy R Marks; Wei K Zhao; Jeffrey K Lee; Chyke A Doubeni; Ann G Zauber; Jolanda de Boer; Bruce H Fireman; Joanne E Schottinger; Virginia P Quinn; Nirupa R Ghai; Theodore R Levin; Charles P Quesenberry Journal: N Engl J Med Date: 2014-04-03 Impact factor: 91.245
Authors: Karina W Davidson; Michael J Barry; Carol M Mangione; Michael Cabana; Aaron B Caughey; Esa M Davis; Katrina E Donahue; Chyke A Doubeni; Alex H Krist; Martha Kubik; Li Li; Gbenga Ogedegbe; Douglas K Owens; Lori Pbert; Michael Silverstein; James Stevermer; Chien-Wen Tseng; John B Wong Journal: JAMA Date: 2021-05-18 Impact factor: 56.272
Authors: Steven J Atlas; Anna N A Tosteson; Timothy E Burdick; Adam Wright; Erica S Breslau; Tin H Dang; Amy J Wint; Rebecca E Smith; Kimberly A Harris; Li Zhou; Jennifer S Haas Journal: JAMA Netw Open Date: 2022-09-01