Capsule Commentary on Mehta et al. Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System
J Gen Intern Med
Capsule Commentary on Mehta et al. Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System
David H. Howard ) 0
0 Department of Health Policy and Management, Emory University , Atlanta, GA , USA
Compliance with Ethical Standards:
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W request but is not actively offered to patients, patients
hen colon cancer screening is available by patient
who are more knowledgeable and more comfortable
interacting with the health system will be more likely to
receive it.1 Programs that reduce the role of patient initiative
should reduce variation in screening rates due to patient
characteristics such as race. Kaiser Permanente of Northern
California put this theory to the test by implementing a program,
including automated medical alerts and mailed FIT tests, to
increase colon cancer screening rates among enrollees.2 The
components of the program were consistent with
evidencedbased recommendations for increasing screening by the Center
for Disease Control and Prevention’s Community Preventive
Services Task Force.3 As a fully integrated delivery system,
Kaiser has the ability to implement programs that other
systems, many of which are striving to become more like Kaiser,
do not. Still, many of the features of this particular program
could be adopted by other health systems or large primary care
practices.
Screening rates increased from 35 % in 2004 to 90 % 2013.
Screening rates in the early period will be underestimated if
the investigators count a patient who received a colonoscopy
or sigmoidoscopy shortly before the beginning of the study
period as unscreened. Screening rates for later years in the
analysis are measured using a longer look-back period. Still,
even if the actual increase was slightly less than the reported
increase, the result is impressive in comparison with screening
rates nationally. In 2013, the colorectal cancer screening rate
among individuals aged 50 to 75 nationally was only 59 %.4
Screening rates increased among all groups, but, somewhat
surprisingly, differences between non-Hispanic whites and
Hispanics, blacks, and Native Americans remained or
widened over time. Even though the intervention was not
specifically targeted at disparities, the result is still surprising. One
would think that these groups would be most likely to benefit
from proactive outreach. The result highlights the challenges
in ensuring that all groups in society benefit from medical
technologies.
Conflict of Interest: The author has no conflicts of interest with any of
the material in this manuscript.
1. Peterson NB , Dwyer KA , Mulvaney SA , Dietrich MS , Rothman RL . The influence of health literacy on colorectal cancer screening knowledge, beliefs and behavior . J Natl Med Assoc . 2007 ; 99 ( 10 ): 1105 - 1112 .
2. Mehta SJ , Jensen CD , Quinn VP , Schottinger JE , Zauber AG , Meester R , et al. Race/ethnicity and adoption of a population health management approach to colorectal cancer screening in a community-based healthcare system . J Gen Intern Med . doi:10.1007/s11606- 016 - 3792 -1
3. Community Preventive Services Task Force . Updated recommendations for client- and provider-oriented interventions to increase breast, cervical, and colorectal cancer screening . Am J Prev Med . 2012 ; 43 : 92 - 96 .
4. National Cancer Institute. Cancer Trends Progress Report. NIH , DHHS, Bethesda, MD, March 2015 , http://progressreport.cancer.gov (...truncated)