Table 1.
Simulated Interventions and Estimates of Effectiveness and Cost.
| Interventiona | Intervention Description | Estimated Relative Risk of Effectivenessb (Range) |
Cost (per patient unless otherwise noted) |
|---|---|---|---|
| Academic detailing & provider assessment and feedback (Detailing+) | A clinic-level intervention that consists of provider education and monitoring of CRC screening practices. The onsite provider training covers the importance of CRC screening, how to talk to patients about CRC screening, and best-practices for encouraging patients to get screened for CRC. Each provider receives an individual quarterly report describing progress in boosting CRC screening rates amongst patients, including specialized recommendations for improvement. |
1.27 (1.20, 1.30)10,40 |
$1,583.04 per clinic40,51,52 |
| Patient reminders (Reminders) | Patients receive automated call(s) to notify them that they are overdue for CRC screening. The automated message includes the notification that they are overdue, brief information about why CRC screening is important, and information about various options for screening (e.g., FIT or colonoscopy). |
1.26 (1.20, 1.30)10,42,43 |
$1.4353 |
| Mailing a Fecal Immunochemical Test (FIT) directly to the patient’s home (Mailed FIT) | Patients receive a notification mailed to their house to alert them that they are due for CRC screening and will be receiving a FIT in the mail that they can complete at home and return to the clinic via mail (or that they can contact the clinic to schedule a colonoscopy). Shortly after, patients receive a package by mail that includes: a low-literacy information sheet about CRC and why screening is important, a FIT, directions for how to complete the FIT, and a pre-addressed envelope with a stamp to return the FIT for processing. Patients also receive up to two automated phone calls to remind them to complete the FIT if they have not yet mailed it back. |
2.17 (2.10, 2.25)10,43 |
$20.8453,54 |
| Patient navigation (Navigation) | A trained patient navigator calls eligible patients to help “navigate” them towards getting screened for CRC with the goal of overcoming any barriers to screening, and to support diagnostic testing and treatment initiation. Patients receive individualized assistance such that the navigator’s actions are dependent on what each patient needs. Navigation may include explaining why CRC screening is important, describing where and how to get screened, helping to arrange transportation to a screening center, ordering a FIT to the patient’s house, and answering questions about CRC screening. |
1.65 (1.60, 1.76)10,44,45 |
$1,159.6453,55,57,58 |
| Mailed FIT + patient navigation (Mailed FIT +Navigation) | The combination of Mailed FIT and Navigation, both described above. In this intervention, navigators focus more commonly on FIT completion or follow-up after an abnormal FIT. |
2.43 (2.40, 2.55)10,46,47 |
$1,180.4853,55,57,58 |
a
Although observed in use in Oregon, we did not model the impact of mass media, patient incentives, or provider incentives because of limited evidence of effectiveness with low or medium risk of bias.
b
The likelihood that an individual is up-to-date with screening is increased above usual care estimates of screening where relative risk values greater than one correspond to increased effectiveness.