New research shows that a combined effort of mailing stool-based tests and providing patient navigation to follow-up procedures significantly increased screenings for colorectal cancer, or CRC, among Medicaid enrollees in rural areas.
The study was a collaborative effort between Oregon Health & Science University's Oregon Rural Practice-based Research Network and the Kaiser Permanente Center for Health Research. Itinvolved 28 clinics in rural Oregon, in partnership with three Medicaid health plans and aimed to tackle low participation in CRC screening, a longstanding challenge in such areas. The results were published today in JAMA Network Open.
Approximately 60 million adults live in the rural United States, where CRC screening rates have traditionally been low, especially among Medicaid recipients. Screening for colorectal cancer is crucial for early detection and prevention. The trial aimed to improve participation by using mailed fecal immunochemical tests, or FIT kits, and offering patient navigation for follow-up colonoscopies if results were abnormal.
"Effective treatments can be slow to reach rural populations," said the study's senior author, Melinda Davis, Ph.D., M.C.R., director of OHSU's Oregon Rural Practice-based Research Network. "This research and other studies by our team help bridge this gap to ensure all patients receive high-quality care, whether they live in rural or urban areas."
The research involved 5,614 Medicaid enrollees aged 50 to 75, with the clinics divided into two groups: one received the intervention, while the other followed usual care practices. The intervention involved two steps: first sending out FIT kits by mail and then providing patient navigation to guide individuals toward colonoscopy, if their test results were abnormal.
Gloria Coronado, Ph.D., an epidemiologist and associate director of population science for the University of Arizona Cancer Center and professor in the UA Mel and Enid Zuckerman College of Public Health, co-led the randomized study.
"Medicaid provides coverage for low-income individuals in the U.S. Individuals who live in rural regions often face additional barriers to receiving cancer screening exams," Coronado said. "We partnered with Medicaid health plans because they could offer centralized resources to promote colorectal cancer screening."
The results were promising. In the intervention group, 11.8% of participants completed CRC screening within six months, compared with just 4.5% in the usual care group. Additionally, those in the intervention group who had abnormal FIT results were much more likely to complete a follow-up colonoscopy — 43.3% compared with just 15.4% in the usual care group.
"CRC screening is so effective, but also really complicated for clinical practices to implement," said Jennifer Coury, M.S., senior research project manager for ORPRN and a coauthor on the study.
"The most rewarding part of this research study was really getting to work with rural practices to improve the health of their population."
The study also found that the implementation of the program was largely successful. All eligible participants received their FIT kits, and most were sent notifications or reminders. However, only about 58% of those who needed follow-up colonoscopy were successfully navigated through the process.
"Implementing mailed FIT outreach and patient navigation improves screening which saves lives from the second leading cause of cancer death in the U.S.," Davis said. "Our research demonstrates the value of national investments in biomedical research and the value of studies which address patient and system-level factors that present barriers to health care access."
This adds to a growing body of evidence supporting the effectiveness of mailed tests and patient navigation, especially for rural and Medicaid populations. The researchers said future efforts could focus on reaching people who lack a primary care provider, as these individuals are less likely to participate in preventive screenings, or to cluster support outreach for multiple cancer screenings concurrently.
In addition to Davis, Coury and Coronado, coauthors include Robert Durr, M.P.H., and Brittany Badicke, M.P.H., with OHSU; and Amanda Petrik, Ph.D., Michael Leo, Ph.D., and Jamie Thompson, M.P.H., and Anna Edelmann, M.S., with Kaiser Permanente Center for Health Research.
Research reported in this publication was supported by the National Center for Advancing Translational Sciences and the National Cancer Institute, both of the National Institutes of Health, under Award Numbers UL1TR002369 and UH3CA244298. Research was also supported by The National Cancer Institute consortium program titled Accelerating Colorectal Cancer Screening and Follow-up through Implementation Science (ACCSIS). Content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
