• Rebekah E Scott, Patrick Chang, Nicole Kluz, Eda Baykal-Caglar, Deepak Agrawal, and Michael Pignone.
• Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
• J Gen Intern Med. 2023 May 1; 38 (7): 163116371631-1637.

BackgroundMailed stool testing programs increase colorectal cancer (CRC) screening in diverse settings, but whether uptake differs by key demographic characteristics is not well-studied and has health equity implications.ObjectiveTo examine the uptake and equity of the first cycle of a mailed stool test program implemented over a 3-year period in a Central Texas Federally Qualified Health Center (FQHC) system.DesignRetrospective cohort study within a single-arm intervention.ParticipantsPatients in an FQHC aged 50-75 at average CRC risk identified through electronic health records (EHR) as not being up to date with screening.InterventionsMailed outreach in English/Spanish included an introductory letter, free-of-charge fecal immunochemical test (FIT), and lab requisition with postage-paid mailer, simple instructions, and a medical records update postcard. Patients were asked to complete the FIT or postcard reporting recent screening. One text and one letter reminded non-responders. A bilingual patient navigator guided those with positive FIT toward colonoscopy.Main MeasuresProportions of patients completing mailed FIT in response to initial cycle of outreach and proportion of those with positive FIT completing colonoscopy; comparison of whether proportions varied by demographics and insurance status obtained from the EHR.Key ResultsOver 3 years, 33,606 patients received an initial cycle of outreach. Overall, 19.9% (n = 6672) completed at least one mailed FIT, 5.6% (n = 374) tested positive during that initial cycle, and 72.5% (n = 271 of 374) of those with positive FIT completed a colonoscopy. Hispanic/Latinx, Spanish-speaking, and uninsured patients were more likely to complete mailed FIT compared with white, English-speaking, and commercially insured patients. Spanish-speaking patients were more likely to complete colonoscopy after positive FIT compared with English-speaking patients.ConclusionsMailed FIT outreach with patient navigation implemented in an FQHC system was effective in equitably reaching patients not up to date for CRC screening.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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