Breaking through the ceiling for colon cancer screening

Background: Let’s face it: no one likes dealing with poop. Colon cancer has an excellent prognosis however, if detected early. Although there are a variety of effective screening methods, even the top ten percent of health programs nationwide have only screened 74.2 % of the their at risk population based on aggregate data from 2011. The Military Health System (MHS), despite having what is nearly “free” medical care and minimal out of pocket expenses, does more poorly, with only 72.78 % of at-risk patients screened as of October 2012. Possible reasons for not obtaining colon cancer screening include not wanting to undergo the uncomfortable “prep” for the procedure which also usually involves taking a day off of work to recover from the sedation used. The fecal immunohistochemical testing is an alternative to colonoscopy that is simpler to use and more sensitive than older fecal occult blood testing. Fecal immunohistochemical testing does not require any dietary restrictions which the older occult blood screens require, and only requires one stool sample compared to three consecutive samples in occult blood screens. As a result, this test could be especially useful to screen the “colonoscopy-averse” population.

Proposal: Fort Belvoir Community Hospital FBCH) currently uses a mail reminder system to notify patients who need colon cancer screening using the MHS Population Health Portal (MHSPHP) action list for colon cancer screening. Patients get up to four reminder letters a year if they remain on the MHSPHP colon cancer action list. We propose enclosing the iFBOT screening kit, which is one brand of fecal immunohistochemical tests, in one of these reminders, and tracking the response rate.
The estimated cost of such as program would be an additional $8 per patient per year over the current cost of sending reminder letters. This cost includes the cost of the kits plus the increase in mailing costs. FBCH currently has about 6000 patients who are not current on colon cancer screening. The two main measures of success would be 1) the overall performance as measured by the MHSPHP at FBCH for colon cancer screening and 2) the percentage of patients mailed iFBOT kits who return them for testing.

Implications: If successful in both the primary and secondary metrics, this is an inexpensive program that could be easily replicated across the MHS improving colon cancer screening rates and ultimately the health of our patients.

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