Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
Kaiser Permanente Division of Research, Oakland, California.
Clin Gastroenterol Hepatol. 2022 Jan;20(1):145-152. doi: 10.1016/j.cgh.2020.09.042. Epub 2020 Sep 30.
Programmatic colorectal cancer (CRC) screening increases uptake, but the design and resources utilized for such models are not well known. We characterized program components and participation at each step in a large program that used mailed fecal immunochemical testing (FIT) with opportunistic colonoscopy.
Mixed-methods with site visits and retrospective cohort analysis of 51-75-year-old adults during 2017 in the Kaiser Permanente Northern California integrated health system.
Among 1,023,415 screening-eligible individuals, 405,963 (40%) were up to date with screening at baseline, and 507,401 of the 617,452 not up-to-date were mailed a FIT kit. Of the entire cohort (n = 1,023,415), 206,481 (20%) completed FIT within 28 days of mailing, another 61,644 (6%) after a robocall at week 4, and 40,438 others (4%) after a mailed reminder letter at week 6. There were over 800,000 medical record screening alerts generated and about 295,000 FIT kits distributed during patient office visits. About 100,000 FIT kits were ordered during direct-to-patient calls by medical assistants and 111,377 people (11%) completed FIT outside of the automated outreach period. Another 13,560 (1.3%) completed a colonoscopy, sigmoidoscopy, or fecal occult blood test unrelated to FIT. Cumulatively, 839,463 (82%) of those eligible were up to date with screening at the end of the year and 12,091 of 14,450 patients (83.7%) with positive FIT had diagnostic colonoscopy.
The >82% screening participation achieved in this program resulted from a combination of prior endoscopy (40%), large initial response to mailed FIT kits (20%), followed by smaller responses to automated reminders (10%) and personal contact (12%).
计划中的结直肠癌（CRC）筛查可提高参与率，但此类模式的设计和所利用的资源尚不清楚。我们对一个大型项目的各个步骤中的项目组成部分和参与情况进行了描述，该项目使用邮寄粪便免疫化学检测（FIT）结合机会性结肠镜检查。
在 2017 年 Kaiser Permanente 北加利福尼亚综合医疗系统中，对 51-75 岁的成年人进行了现场考察和回顾性队列分析，采用混合方法。
在 1023415 名符合筛查条件的人群中，405963 人（40%）在基线时接受了最新筛查，而在 617452 名未及时接受筛查的人群中，有 507401 人收到了 FIT 试剂盒。在整个队列（n=1023415）中，206481 人（20%）在邮寄后 28 天内完成了 FIT，另有 61644 人（6%）在第 4 周接到机器人电话后完成了 FIT，还有 40438 人（4%）在第 6 周收到邮寄提醒信后完成了 FIT。在患者就诊期间，共生成了超过 80 万次的医疗记录筛查警报，并分发了大约 295000 个 FIT 试剂盒。在医疗助理的直接患者电话咨询中，有 100000 个 FIT 试剂盒被订购，有 111377 人（11%）在自动化外展期之外完成了 FIT。另有 13560 人（1.3%）完成了与 FIT 无关的结肠镜检查、乙状结肠镜检查或粪便潜血检查。总的来说，在年底时，839463 名符合条件的人（82%）接受了筛查，在 14450 名阳性 FIT 患者中，有 12091 人（83.7%）接受了诊断性结肠镜检查。
该项目中超过 82%的筛查参与率是由先前的内镜检查（40%）、对邮寄 FIT 试剂盒的大量初始反应（20%）、随后对自动提醒（10%）和个人联系（12%）的较小反应共同促成的。
