TY - JOUR
T1 - Mailed Outreach Program Increases Ultrasound Screening of Patients With Cirrhosis for Hepatocellular Carcinoma
AU - Singal, Amit G.
AU - Tiro, Jasmin A.
AU - Marrero, Jorge A.
AU - McCallister, Katharine
AU - Mejias, Caroline
AU - Adamson, Brian
AU - Bishop, Wendy Pechero
AU - Santini, Noel O.
AU - Halm, Ethan A.
N1 - Funding Information:
Funding This study was conducted as part of the Center for Patient-Centered Outcomes Research with support from Agency for Healthcare Research and Quality grant R24 HS022418, National Center for Advancing Translational Sciences of the National Institutes of Health grant UL1TR001105, and National Institutes of Health/National Cancer Institute cancer center support grant P30 CA142543. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Agency for Healthcare Research and Quality. The funding agency had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, and approval of the manuscript.
Publisher Copyright:
© 2017 AGA Institute
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Background & Aims Surveillance of patients with cirrhosis increases early detection of hepatocellular carcinoma (HCC) and prolongs survival. However, its effectiveness is limited by underuse, particularly among racial/ethnic minorities and individuals of low socioeconomic status. We compared the effectiveness of mailed outreach strategies, with and without patient navigation, in increasing the numbers of patients with cirrhosis undergoing surveillance for HCC in a racially diverse and socioeconomically disadvantaged cohort. Methods We performed a prospective study of patients with documented or suspected cirrhosis at a large safety-net health system from December 2014 through March 2016. Patients were assigned randomly (1:1:1) to groups that received mailed invitations for an ultrasound screening examination (n = 600), mailed invitations for an ultrasound screening examination and patient navigation (barrier assessment and motivational education for patients who declined screening; n = 600), or usual care (visit-based screening; n = 600). Patients who did not respond to outreach invitations within 2 weeks received up to 3 reminder telephone calls. The primary outcome was completion of abdominal imaging within 6 months of randomization. Results Baseline characteristics were similar among groups. Cirrhosis was documented, based on International Classification of Diseases, 9th revision, codes, for 79.6% of patients, and suspected, based on noninvasive markers of fibrosis, for 20.4%. In an intent-to-treat analysis, significantly greater proportions of patients who received the mailed invitation and navigation (47.2%) or the mailed invitation alone (44.5%) underwent HCC screening than patients who received usual care (24.3%) (P <.001 for both comparisons). However, screening rates did not differ significantly between outreach the outreach groups (P =.25). The effects of the outreach program were consistent in all subgroups, including Caucasian vs non-Caucasian race, documented vs suspected cirrhosis, Child–Pugh A vs B cirrhosis, and receipt of gastroenterology care. Conclusions In a prospective study, we found outreach strategies to double the percentage of patients with cirrhosis who underwent ultrasound screening for HCC. However, adding patient navigation to telephone reminders provided no significant additional benefit. ClinicalTrials.gov no: NCT02312817.
AB - Background & Aims Surveillance of patients with cirrhosis increases early detection of hepatocellular carcinoma (HCC) and prolongs survival. However, its effectiveness is limited by underuse, particularly among racial/ethnic minorities and individuals of low socioeconomic status. We compared the effectiveness of mailed outreach strategies, with and without patient navigation, in increasing the numbers of patients with cirrhosis undergoing surveillance for HCC in a racially diverse and socioeconomically disadvantaged cohort. Methods We performed a prospective study of patients with documented or suspected cirrhosis at a large safety-net health system from December 2014 through March 2016. Patients were assigned randomly (1:1:1) to groups that received mailed invitations for an ultrasound screening examination (n = 600), mailed invitations for an ultrasound screening examination and patient navigation (barrier assessment and motivational education for patients who declined screening; n = 600), or usual care (visit-based screening; n = 600). Patients who did not respond to outreach invitations within 2 weeks received up to 3 reminder telephone calls. The primary outcome was completion of abdominal imaging within 6 months of randomization. Results Baseline characteristics were similar among groups. Cirrhosis was documented, based on International Classification of Diseases, 9th revision, codes, for 79.6% of patients, and suspected, based on noninvasive markers of fibrosis, for 20.4%. In an intent-to-treat analysis, significantly greater proportions of patients who received the mailed invitation and navigation (47.2%) or the mailed invitation alone (44.5%) underwent HCC screening than patients who received usual care (24.3%) (P <.001 for both comparisons). However, screening rates did not differ significantly between outreach the outreach groups (P =.25). The effects of the outreach program were consistent in all subgroups, including Caucasian vs non-Caucasian race, documented vs suspected cirrhosis, Child–Pugh A vs B cirrhosis, and receipt of gastroenterology care. Conclusions In a prospective study, we found outreach strategies to double the percentage of patients with cirrhosis who underwent ultrasound screening for HCC. However, adding patient navigation to telephone reminders provided no significant additional benefit. ClinicalTrials.gov no: NCT02312817.
KW - Intervention
KW - Liver Cancer
KW - Prevention
KW - Randomized Controlled Trial
UR - http://www.scopus.com/inward/record.url?scp=85010711876&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85010711876&partnerID=8YFLogxK
U2 - 10.1053/j.gastro.2016.10.042
DO - 10.1053/j.gastro.2016.10.042
M3 - Article
C2 - 27825963
AN - SCOPUS:85010711876
SN - 0016-5085
VL - 152
SP - 608-615.e4
JO - Gastroenterology
JF - Gastroenterology
IS - 3
ER -