• Karin L Kempe, Susan M Shetterly, Eric K France, and Theodore R Levin.
• Clinical Prevention Services, Population Care and Prevention Services, Kaiser Permanente Colorado, Denver, CO, USA. karinkempe@comcast.net
• Am J Manag Care. 2020 Dec 7; 18 (7): 370-8.

ObjectivesTo evaluate a population outreach program to promote screening for colorectal cancer (CRC) among average-risk insured men and women.Study DesignIn 2008, 58,440 Kaiser Permanente Colorado members unscreened for CRC received an interactive voice response (IVR) call followed by mailed fecal immunochemical test (FIT), or colonoscopy if requested. We used a quasi-experimental design with staged implementation, in which a random subset of eligible members was selected each week to receive the intervention. This design allowed the entire group to ultimately receive the intervention.MethodsSurvival models summarized time-specific comparisons of screening behaviors for members who received immediate outreach compared with those who had not yet received it.ResultsA total of 26,003 (45%) of the unscreened population completed screening, predominately due to the mailed kits. The unadjusted hazard ratio (HR) for the outreach effect on screening completion was 4.08 (95% confidence interval: 3.93-4.25) and adjusted HR was 3.75 (3.60-3.91). Lower levels of screening were seen in African Americans (HR 0.83; 0.77-0.90) and Hispanics (HR 0.84; 0.80-0.88) compared with whites, and in smokers (HR 0.77; 0.74-0.80) compared with nonsmokers. The outreach had greater impact among those without a primary care (HR 4.5 vs 3.0, P <.0001) or specialty care (HR 5.2 vs 3.5, P <.0001) visit compared with those with 1 or more visits.ConclusionsThe rate of colorectal cancer screening in members after mailed FIT with IVR was almost 4 times higher than usual care, particularly in those without an office visit. Targeted approaches are needed for groups at risk for not screening.

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