Mailings timed to patients' appointments - A controlled trial of fecal occult blood test cards

Background: Fecal occult blood testing (FOBT) programs cost-effectively reduce colon cancer mortality. To improve the rate of colon cancer screening with FOBT, we tested the effect of mailing FOBT cards timed to appointments on the rates of completion of FOBT. Design: Controlled trial. Setting/Participants: A total of 119 patients with primary care appointments scheduled in May or June 2000 for an urban, public hospital clinic that serves predominantly low-income, African Americans with chronic diseases. The patients in the study were selected by linking a quality improvement registry, the appointment system database, and an FOBT database to generate a list of clinic patients who had not completed an FOBT in the preceding year. Intervention: Subjects were assigned to either a system of mailing FOBT cards and reminders 2 weeks prior to a scheduled appointment or usual care. Main Outcome Measures: The primary outcomes were the rate of screening at the index appointment and during the year beginning with the date of the index appointment. Results: The rate of return of the FOBT cards during the year beginning with the index appointment was 40.7% for the intervention group compared to 5% for the Usual care group (odds ratio [OR] = 13.0, p < 0.001). The difference was accounted for largely by increases in screening at the index appointment (35.6% compared to 3.3%, OR = 16.0, P < 0.001). Conclusions: Using computer databases to generate a list of patients due for FOBT and then mailing FOBT cards timed to a scheduled appointment significantly increased the rate of colon cancer screening. This may be an efficient approach to increasing colon cancer screening with FOBT.