A centralized, automated approach to identify those patients who were not screened regularly for cancers of the colon and rectum doubled this group's rates of on-time screening and reduced health care costs during a 2-year period, according to the results of a new randomized controlled trial.[1] The Systems of Support to Increase Colorectal Cancer Screening trial identified 4675 patients aged 50 to 73 years who were not up-to-date for their colorectal cancer screening. They were randomly assigned to 1 of 4 groups:

  • Usual care, with both clinic and patient reminders for those overdue for screening.
  • Usual plus automated care, which included a letter reminding patients they were overdue as well as a pamphlet on colon cancer screening options; flexible sigmoidoscopy every 5 years; or colonoscopy every 10 years. Patients who did not schedule a colonoscopy were sent a fecal occult blood testing kit in the mail with instructions and a postage- paid return envelope, followed by another reminder 3 weeks later.
  • Usual care, automated interventions, and assisted care if patients had not completed screening. The latter included a telephone call from a medical assistant and assistance to complete the screening.
  • All of the above steps as well as navigated care if patients were still overdue for screening or requested a colonoscopy or sigmoidoscopy during the assisted or automated steps, which included assistance facilitating screenings and appointments.

Each step improved the percentage of patients who were current for their screenings: 26% for usual care; 51% for usual care plus automated interventions; 57% for usual care, automated interventions, and assisted care; and 65% for all of the above plus navigated care. Next, researchers plan to test whether improved adherence continues for more than 2 years.


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  2. Reference
  • 1
    Green BB , Wang CY , Anderson ML , et al. An automated intervention with stepped increases in support to increase uptake of colorectal cancer screening: a randomized trial. Ann Intern Med. 2013;158(5 pt 1):301-311.