Effectiveness of a patient and practice-level colorectal cancer screening intervention in health plan members: the CHOICE trial.

BACKGROUND: Colorectal cancer (CRC) screening reduces CRC incidence and mortality but is underused. Effective interventions to increase screening that can be implemented broadly are needed. METHODS: A controlled trial was conducted to evaluate a patient-level and practice-level intervention to increase the use of recommended CRC screening tests among health plan members. The patient-level intervention was a patient decision aid and included stage-targeted brochures that were mailed to health plan members. Intervention practices received academic detailing to prepare practices to facilitate CRC testing once patients were activated by the decision aid. We used patient surveys and claims data to assess CRC test completion. RESULTS: Among 443 active participants, 75.8% were ages 52 to 59 years, 80.9% were white, 62.1% were women, and 46.4% had college degrees or greater education. Among 380 active participants with known screening status at 12 months based on survey results, 39% in the intervention group reported receiving CRC screening compared with 32.2% in the usual care group (unadjusted odds ratio [OR], 1.34; 95% confidence interval; [CI], 0.88-2.05; P = .17). After adjusting for baseline differences and accounting for clustering, the effect was somewhat larger (OR, 1.64; 95% CI, 0.98-2.73; P = .06). Claims analysis produced similar effects for active participants. The intervention was more effective in those who had incomes >$50,000 (OR, 2.16; 95% CI, 1.07-4.35) than in those who had lower incomes (OR, 1.25; 95% CI, 0.53-2.94; P = .03 for interaction). CONCLUSIONS: Interventions combining a patient-directed decision aid and practice-directed academic detailing had a modest but statistically nonsignificant effect on CRC screening rates among active participants.

Yield of claims data and surveys for determining colon cancer screening among health plan members.

Screening can reduce incidence and mortality from colorectal cancer but has been underutilized. Efforts to increase screening depend on accurate data about screening status. We sought to evaluate the independent and combined yield of claims and direct survey for identifying colorectal cancer screening among average-risk health plan beneficiaries. Participants were Aetna members ages between 52 and 80 years from 32 primary care practices in Florida and Georgia participating in the Communicating Health Options through Information and Cancer Education study. Main outcomes were the proportion of average-risk patients who were up-to-date with colorectal cancer screening based on claims data and the estimated additional yield of survey data for patients with no evidence of screening in their claims history. Of 4,020 average-risk members identified, claims data indicated that 1,066 (27%) had recent colorectal cancer screening. Among the 1,269 average-risk members with no evidence of screening by claims data who returned surveys, 498 (39%) reported being up-to-date with screening. Combining claims data and survey data and accounting for survey nonresponse, we estimate that 47% to 59% of member patients were actually up-to-date with screening, an additional yield of 20 to 32 percentage points. We conclude that, among health plan members, the combination of claims data and survey information had substantially higher yield than claims data alone for identifying colorectal cancer screening.

Trends in healthcare use in the New York City region following the Terrorist Attacks of 2001.

BACKGROUND: In 2001, terrorism led to emotional stress, disruptions in adherence to treatments and access to services, and exposure to environmental contaminants in New York City (NYC). METHODS: To describe healthcare use following the terrorist attacks of 2001, we examined insurance claims for January 2000 to March 2002 among more than 2 million residents of the NYC region who were enrolled in the health plans of a large insurer, including overall use by care setting and use for selected conditions that may be associated with stress or other disaster consequences. For all enrollees and for those residing at varying distances from the World Trade Center (WTC), we compared observed use to expected use, based on comparable intervals in prior years and adjusted for seasonal and secular trends. RESULTS: Use declined across all care settings in the 3 weeks following September 11. From October 1 to December 31, 2001, outpatient visits rose beyond expected both overall and for specific cardiovascular, gastrointestinal, and dermatologic conditions. Declines in overall mental health service use began immediately after September 11 and were sustained through March 2002. Changes in healthcare use were more marked among those residing within 10 miles of the WTC than those residing at greater distances. CONCLUSIONS: A transient decline in visits across all settings occurred immediately after September 11, followed by a sustained increase in demand for health care for conditions that may be associated with stress or other disaster consequences.

Effectiveness of a patient- and practice-level colorectal cancer screening intervention in health plan members: design and baseline findings of the CHOICE trial.

BACKGROUND: : Evidence-based interventions have been found effective in increasing colorectal cancer (CRC) screening. Translating these successful interventions into real world settings, such as health plans, can be challenging. METHODS: : CHOICE (Communicating Health Options through Information and Cancer Education) is a controlled trial to test the effectiveness of a patient- and practice-level intervention to increase use of recommended CRC screening tests. The patient-level intervention was a patient decision aid and stage-targeted brochures, mailed to eligible health plan members, to provide information about CRC, available screening tests, and how to obtain CRC screening at their physicians' practices. The practice-level intervention was academic detailing to prepare practices to facilitate CRC testing once the patient was activated by the decision aid. Surveys and claims data will be used to assess CRC screening test completion. RESULTS: : Thirty-two primary care practices in Florida and Georgia participated. The authors recruited 443 participating health plan members for the trial; 211 were patients in intervention practices, and 232 were in usual care practices. Study participants reflected an insured population; the majority were white and aged <60 years. The authors also mailed the intervention to 343 people from intervention practices who did not respond to the eligibility or baseline survey. Receipt of screening in that group will be compared with screening among 319 people from usual care practices who did not respond to these surveys using claims data. CONCLUSIONS: : The CHOICE study will demonstrate the effect of 2 combined evidence-based interventions on CRC screening test completion among health plan members. Cancer 2010. (c) 2010 American Cancer Society.