In a study reported in JAMA, Atlas et al found that a primary care intervention including electronic health record (EHR) reminders and patient outreach with or without patient navigation improved timeliness of follow-up of overdue abnormal cancer screening test results.
Study Details
The open-label cluster randomized trial—conducted in 44 primary care practices in 3 U.S. health networks—enrolled patients with at least one abnormal screening test for colorectal, breast, cervical, or lung cancer who had not yet followed up between August 2020 and December 2021.
Primary care practices were randomly allocated 1:1:1:1 to:
- Usual care (n = 2,702)
- EHR reminders (n = 3,254)
- EHR reminders and outreach consisting of a letter to the patient at week 2 and a phone call at week 4 (n = 2,569)
- EHR reminders, outreach, and navigation, consisting of a patient letter at week 2 and patient navigator phone call at week 4 (n = 3,455).
The primary outcome measure was completion of recommended follow-up within 120 days of study enrollment.
Key Findings
Among 11,980 patients in the study (median age = 60 years, interquartile range = 52–69 years), 64.8% were women, 83.3% were White, and 15.4% had Medicaid. A total of 8,245 (69%) had abnormal screening test results for colorectal cancer; 2,596 (22%) for cervical cancer; 1,005 (8%) for breast cancer; and 134 (1%) for lung cancer. Abnormal test results were categorized as low-risk in 6,082 patients (51%); medium-risk in 3,712 (31%); and high-risk in 2,186 (18%).
Adjusted proportions of patients who completed recommended follow-up within 120 days were:
- 31.4% in the EHR reminder/outreach/navigation group (adjusted absolute difference vs usual care group = 8.5%, 95% confidence interval [CI] = 4.8%–12.0%, P < .001)
- 31.0% in the EHR reminder/outreach group (adjusted absolute difference vs usual care group = 8.1%, 95% CI = 4.5%–11.7%)
- 22.7% in the EHR reminder group (adjusted absolute difference vs usual care group = –0.2%, 95% CI = –3.5% to 3.0%)
- 22.9% in the usual care group.
Differences for the EHR reminder/outreach/navigation group and the EHR reminder/outreach group vs the EHR reminder group were statistically significant, whereas the difference between the EHR reminder/outreach/navigation group vs the EHR reminder/outreach group was not significant.
In subgroup analyses, patients with abnormal test results for colorectal cancer in the EHR reminder/outreach/navigation group (odds ratio [OR] = 1.68, 95% CI = 1.32–2.16) and the EHR reminder/outreach group (OR = 1.71, 95% CI = 1.33–2.19) were more likely to complete follow-up vs those in the usual care group. Patients with abnormal results for cervical cancer in the EHR reminder/outreach/navigation group (OR = 1.28, 95% CI = 0.93–1.77) and the EHR reminder/outreach group (OR = 1.51, 95% CI = 1.09–2.09) were more likely to complete follow-up vs those in the usual care group.
Patients with abnormal cancer screening test results that were low- or medium-risk in the EHR reminder/outreach/navigation group (OR for low-risk = 1.66, 95% CI = 1.36–2.02; OR for medium-risk = 1.57, 95% CI = 1.25–1.96) and in the EHR reminder/outreach group (OR for low-risk = 1.58, 95% CI = 1.28–1.95; OR for medium-risk = 1.55, 95% CI = 1.23–1.96) had greater odds of completing follow-up compared with those in the usual care group.
The investigators concluded, “A multilevel primary care intervention that included EHR reminders and patient outreach with or without patient navigation improved timely follow-up of overdue abnormal cancer screening test results for breast, cervical, colorectal, and lung cancer.”
Steven J. Atlas, MD, MPH, of the Division of General Internal Medicine, Massachusetts General Hospital, is the corresponding author for the JAMA article.
Disclosure: The study was supported by grants from the National Cancer Institute and American Cancer Society. For full disclosures of the study authors, visit jamanetwork.com.
