Balancing Adherence and Expense: The Cost-Effectiveness of Two-Sample vs One-Sample Fecal Immunochemical Test.

Colorectal cancer (CRC) causes more than 50,000 deaths each year in the United States but early detection through screening yields survival gains; those diagnosed with early stage disease have a 5-year survival greater than 90%, compared to 12% for those diagnosed with late stage disease. Using data from a large integrated health system, this study evaluates the cost-effectiveness of fecal immunochemical testing (FIT), a common CRC screening tool. A probabilistic decision-analytic model was used to examine the costs and outcomes of positive test results from a 1-FIT regimen compared with a 2-FIT regimen.

Implementation challenges and successes of a population-based colorectal cancer screening program: a qualitative study of stakeholder perspectives.

Background: Few studies describe system-level challenges or facilitators to implementing population-based colorectal cancer (CRC) screening outreach programs. Our qualitative study explored viewpoints of multilevel stakeholders before, during, and after implementation of a centralized outreach program. Program implementation was part of a broader quality-improvement initiative.

Participant uptake of the fecal immunochemical test decreases with the two-sample regimen compared with one-sample FIT.

Background: Fecal immunochemical tests (FITs) are recommended to screen average-risk adults for colorectal cancer (CRC). Little research has examined whether a two-sample FIT affects participant uptake, compared with a one-sample FIT. Examining participant uptake is important, as evidence suggests that a two-sample FIT may increase the sensitivity to detect CRC.

Effect of self-referral on bone mineral density testing and osteoporosis treatment.

Background: Despite national guidelines recommending bone mineral density screening with dual-energy x-ray absorptiometry (DXA) in women aged 65 years and older, many women do not receive initial screening.

Objective: To determine the effectiveness of health system and patient-level interventions designed to increase appropriate DXA testing and osteoporosis treatment through (1) an invitation to self-refer for DXA (self-referral); (2) self-referral plus patient educational materials; and (3) usual care (UC, physician referral).

Research Design: Parallel, group-randomized, controlled trials performed at Kaiser Permanente Northwest (KPNW) and Kaiser Permanente Georgia (KPG).

More comprehensive discussion of CRC screening associated with higher screening.

Objectives: Examine association of comprehensiveness of colorectal cancer (CRC) screening discussion by primary care physicians (PCPs) with completion of CRC screening.

Study Design: Observational study in Kaiser Permanente Northwest, a group-model health maintenance organization.

Methods: A total of 883 participants overdue for CRC screening received an automated telephone call (ATC) between April and June 2009 encouraging CRC screening.

Health care worker perspectives inform optimization of patient panel-support tools: a qualitative study.

Electronic decision-support systems appear to enhance care, but improving both tools and work practices may optimize outcomes. Using qualitative methods, the authors' aim was to evaluate perspectives about using the Patient Panel-Support Tool (PST) to better understand health care workers' attitudes toward, and adoption and use of, a decision-support tool. In-depth interviews were conducted to elicit participant perspectives about the PST-an electronic tool implemented in 2006 at Kaiser Permanente Northwest.

Change to FIT increased CRC screening rates: evaluation of a US screening outreach program.

Objectives: To compare completion rates of colorectal cancer screening tests within a health maintenance organization before and after widespread adoption of the fecal immunochemical test (FIT).

Study Design: Retrospective cohort study.

Methods: Using electronic medical records of 113,901 patients eligible for colorectal cancer screening, we examined test completion during 2 successive time periods among those who received an automated screening outreach call.

Incidence and demography of femur fractures with and without atypical features.

The case definition, community incidence, and characteristics of atypical femoral shaft fractures (FSFs) are poorly understood. This retrospective study utilized electronic medical records and radiograph review among women ≥50 years of age and men ≥65 years of age from January 1996 to June 2009 at Kaiser Permanente Northwest to describe the incidence rates and characteristics of subgroups of femur fractures. Fractures were categorized based on the American Society for Bone and Mineral Research (ASBMR) as atypical fracture major features (AFMs) (low force, shaft location, transverse or short oblique, noncomminuted) and AFMs with additional minor radiograph features (AFMms) (beaking, cortical thickening, or stress fracture).

Primary care colorectal cancer screening recommendation patterns: associated factors and screening outcomes.

Background: The relationship of a primary care provider's (PCP's) colorectal cancer (CRC) screening strategies to completion of screening is poorly understood.

Objective: To describe PCP test recommendation patterns and associated factors and their relationship to patient test completion.

Design: This cross-sectional study used a PCP survey, in-depth PCP interviews, and electronic medical records.

Patient Barriers to Mammography Identified During a Reminder Program.

Patient mammogram reminders are effective at increasing screening, but patient barriers remain. We evaluated patient characteristics and reported barriers for their association with mammogram completion after a reminder program. This retrospective cohort study used data from electronic records and a subgroup survey.

Effect of a patient panel-support tool on care delivery.

Objective: To evaluate the effect of a patient panel-support tool (PST) on care delivery for diabetes mellitus (DM) and cardiovascular disease (CVD).

Study Design: Retrospective longitudinal cohort study among primary care providers (PCPs), with 2005 as the preintervention, 2006 as the implementation, and 2007 as the postintervention period.

Methods: We estimated the intervention effect using electronic medical record data and hierarchical linear models.

Automated telephone calls improved completion of fecal occult blood testing.

Background: Although colorectal cancer (CRC) prognosis is improved by early diagnosis, screening rates remain low.

Objective: To determine the effect of an automated telephone intervention on completion of fecal occult blood testing (FOBT).

Research Design: In this randomized controlled trial conducted at Kaiser Permanente Northwest, a not-for-profit health maintenance organization, 5905 eligible patients aged 51 to 80, at average risk for CRC and due for CRC screening, were randomly assigned to an automated telephone intervention (n = 2943) or usual care (UC; n = 2962).

Efficacy of continued alendronate for fractures in women with and without prevalent vertebral fracture: the FLEX trial.

In the Fracture Intervention Trial (FIT) Long Term Extension (FLEX) Trial, 10 years of alendronate (ALN) did not significantly reduce the risk of nonvertebral fractures (NVFs) compared with 5 years of ALN. Continuing ALN reduced the risk of clinical but not morphometric vertebral fractures regardless of baseline vertebral fracture status. In previous studies, ALN efficacy for NVF prevention in women without prevalent vertebral fracture was limited to those with femoral neck (FN) T-scores of -2.

Association of cardiometabolic risk factors and prevalent cardiovascular events.

Background: Although cardiovascular disease causes substantial morbidity and mortality, how individual and groups of risk factors contribute to cardiovascular outcomes is incompletely understood. This study evaluated cardiometabolic risk factors and their relationship to prevalent diagnosis of acute myocardial infarction (AMI) and stroke.

Methods: We used retrospective data from 3 integrated health-care systems that systematically collect and store detailed patient-level data.

Effect of a multimodal reminder program on repeat mammogram screening.

Background: Patient mammogram reminders are effective but have not been fully implemented in practice to improve routine screening. The effectiveness of implementation and maintenance phases of a multimodal reminder program that incorporated automated calls capable of efficiently reaching large numbers of women was evaluated to improve repeat mammography screening.

Design: A quasi-experimental study was conducted in 2008 using electronic medical record data during three time periods: pre-reminder phase (2004), post-reminder implementation phase (2006), and post-reminder maintenance phase (January 1-July 1, 2007).

Reducing the prescribing of heavily marketed medications: a randomized controlled trial.

Context: Prescription drug costs are a major component of health care expenditures, yet resources to support evidence-based prescribing are not widely available.

Objective: To evaluate the effectiveness of computerized prescribing alerts, with or without physician-led group educational sessions, to reduce the prescribing of heavily marketed hypnotic medications.

Design: Cluster-randomized controlled trial.

Improving laboratory monitoring of medications: an economic analysis alongside a clinical trial.

Objective: To test the efficiency and cost-effectiveness of interventions aimed at enhancing laboratory monitoring of medication.

Study Design: Cost-effectiveness analysis.

Methods: Patients of a not-for-profit, group-model HMO were randomized to 1 of 4 interventions: an electronic medical record reminder to the clinician, an automated voice message to patients, pharmacy-led outreach, or usual care.

Effectiveness of bisphosphonate therapy in a community setting.

Background: Osteoporosis is a major cause of morbidity and mortality. Clinical trials have shown the effectiveness of bisphosphonates, the most commonly prescribed treatments, in reducing fracture risk. The population-based effectiveness of bisphosphonates in clinical practice is uncertain.

Weight change in diabetes and glycemic and blood pressure control.

Objective: Weight loss in type 2 diabetes is undisputedly important, and data from community settings are limited. We evaluated weight change and resulting glycemic and blood pressure control in type 2 diabetic patients at an HMO.

Research Design And Methods: Using electronic medical records, this retrospective cohort study identified 2,574 patients aged 21-75 years who received a new diagnosis of type 2 diabetes between 1997 and 2002.

Weight change and glycemic control after diagnosis of type 2 diabetes.

Background: Limited community-based data describe weight change after diabetes diagnosis.

Objective: To evaluate weight change patterns and associations in the 1st year after diabetes mellitus type 2 diagnosis.

Design: Retrospective cohort study.

A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice.

Background: Although numerous studies address the efficacy and effectiveness of health interventions, less research addresses successfully implementing and sustaining interventions. As long as efficacy and effectiveness trials are considered complete without considering implementation in nonresearch settings, the public health potential of the original investments will not be realized. A barrier to progress is the absence of a practical, robust model to help identify the factors that need to be considered and addressed and how to measure success.

Does a history of non-vertebral fracture identify women without osteoporosis for treatment?

Background: Postmenopausal women with a prior fracture have an increased risk for future fracture. Whether a history of non-vertebral fracture defines a group of women with low bone mass but without osteoporosis for whom alendronate would prevent new non-vertebral fracture is not known.

Subjects And Methods: Secondary analysis of data from the Fracture Intervention Trial (FIT).

An outreach program improved osteoporosis management after a fracture.

This longitudinal retrospective cohort study evaluated implementation of an intervention to improve management of osteoporosis after a fracture in a nonprofit group-model health maintenance organization (HMO) in the U.S. Pacific Northwest with 480,000 members and electronic medical record data.

Electronic medical records and prevention quality: the prevention index.

Background: The Prevention Index is a methodology for using electronic medical records to identify and evaluate practice variations in the delivery of preventive care.

Methods: The Prevention Index was used to evaluate the provision of 10 recommended adult preventive services using electronic medical record data for the years 1999 through 2002 among the 450,000 members of a large Northwest integrated care system. The analyses were conducted in 2005.