• Ethan A Halm, Rasmi G Nair, Ellen Hu, Lei Wang, Jacquelyn M Lykken, Cynthia Ortiz, Eric J Kim, Noel O Santini, Brett Moran, and Celette Sugg Skinner.
• Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. ethan.halm@rutgers.edu.
• J Gen Intern Med. 2024 May 1; 39 (6): 978984978-984.

BackgroundDespite national policy efforts to increase colorectal cancer (CRC) screening, rates in vulnerable populations remain suboptimal. Many types of interventions have been employed, but their impact on improving population-level rates of CRC screening over time is uncertain.ObjectiveAssess the impact of 10 years of different in-reach and outreach strategies to improve CRC screening and identify factors associated with being screen up-to-date (SUTD).DesignObservational cohort study.ParticipantsPatients aged 50-74 years from 12 community-based primary care clinics in an integrated, regional safety-net health system.InterventionsMultiple system-level interventions were implemented over time (visit-based electronic health record [EHR] reminders, quality measurement, annual preventive service letters, and mailed fecal immunohistochemical stool tests [FIT]).Main MeasuresCRC SUTD rates by calendar year among those with a primary care (PC) visit in the prior 1 and 3 years and their multivariable correlates.Key ResultsThe sample included 31,786-40,405 patients/year. In 2011, mean age was 58.9, 63.9% were women, 37.0% were Hispanic, 39.3% Black, 16.8% White, and 6.6% Asian/Other, and 60.5% were uninsured/Medicaid. Three-quarters of patients had ≥ 1 PC visit in the prior year. Lower-intensity interventions (EHR reminders, quality measurement, annual prevention letters) had limited impact on SUTD rates (2-3% rise). Implementing system-wide mailed FIT increased rates from 51.2 to 61.9% among those with a PC visit in the past year (40.5 to 46.8% with a PC visit ≤ 3 years). Stopping mailed FIT due to COVID wiped out these gains. Higher screening rates were associated with the following: older age; female; more comorbidities, PC clinic visits, and prior FITs; and better insurance coverage. Hispanics had the highest SUTD rates followed by Asians, Blacks, and Whites (p < 0.05).ConclusionsImplementation of a system-wide mailed FIT program had the greatest impact on SUTD rates. Lower-intensity interventions (EHR reminders, quality measurement, and patient letters) had limited effects.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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