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Colorectal Cancer Screening with Programmatic Mass Mailed FIT
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Screening is proven to reduce mortality from colorectal cancer (CRC), the second leading cause of cancer death in the United States. Unfortunately, hundreds of thousands of Veterans are not up to date with screening. To expand access to life-saving screening, the VHA has launched an effort to mail Fecal Immunochemical Test (FIT) kits for CRC screening directly to Veterans so that they can complete screening from the comfort of their homes.
We believe our FIT-first approach, modeled after the successful Kaiser Permanente program, will increase CRC screening adherence, reduce overall costs, increase colonoscopy access for Veterans with the highest risk for CRC, and ultimately save lives.
Origin:
February 2021, VISN-21
Adoptions:
101 successful, 25 in-progress
Awards and Recognition:
SCOPY Award Winner, American College of Gastroenterology, Diffusion of Excellence Promising Practice, VHA Shark Tank Winner
Partners:
Gastroenterology and Hepatology, Office of Primary Care, Oncology, Pathology and Laboratory Medicine Service
Recent Updates
Overview
Problem
Videos
'Stay Ahead' CRC Screening Public Service Announcement
Links
- Interactive decision aid tool for Veterans to learn more about CRC and screening options CRC Screening Tool (Veteran Facing)
Solution
The program is designed to suppo ... In partnership with the National Gastroenterology Program Office, staff from the Sierra Pacific Network (VISN 21) piloted a mailed fecal immunochemical test (FIT) program at the Fresno and Las Vegas Health Care Systems, subsequently expanded to all facilities in the VISN, and is now the model for VHA-wide expansion efforts.
The program is designed to support, not replace, current CRC screening efforts. The FIT-first approach, modeled after the successful Kaiser Permanente program, increases CRC screening adherence, reduces costs, increases colonoscopy access for Veterans with the highest risk for CRC, and saves lives.
The program is simple. Utilizing reports from the national CRC Screening and Surveillance Reminder System, Veterans who are currently due or overdue for average risk CRC screening are mailed a FIT kit to use in their home. Veterans then send samples directly to their local VHA for analysis. Positive samples are referred to the Veteran’s primary care provider for appropriate follow-up, which in most cases should be a colonoscopy. See more
Links
- Site with guidance and tools for VISNs/VAMCs looking to create or expand Mailed FIT programs VHA Mailed FIT SharePoint (internal use only)
- Overview of what a FIT is and how it is used FIT description - Veterans Health Library
Results
Nationally, mailed FIT return rates have varied but average 34%.
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Departments
- Gastroenterology
- Logistics
- Laboratory and pathology
- Primary care
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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Links
- Use this PowerBI Dashboard to identify populations of Veterans at average risk for CRC and overdue for screening Cohort Identification Tool
- Use this dashboard to monitor and evaluate FIT-based screening in your VISN/Facility, including diagnostic colonoscopies completed after an abnormal FIT FIT Process of Care Dashboard
Contact
Comment
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About
Original team
Chris Moore, MPH
Associate Director for Operations, National Colorectal Cancer Screening Program
Jason Dominitz, MD, MHS
Executive Director, National Gastroenterology and Hepatology Program
Douglas Robertson, MD, MPH
Deputy Director, National Colorectal Cancer Screening Program
Anita Patil, MD
Deputy Director, National Colorectal Cancer Screening Program
i would also like more information in adopting this innovation
I would to hear an update on this and how to adopt this innovation
I want to adopt this innovation
Thanks for your interest, Patricia!
We would be interested to hear an update on how other facilities are doing ni adopting this innovation.
The National Center for Health Promotion is excited about this innovation which provides a highly scalable, evidence-based strategy for enhancing Colorectal Cancer (CFC) Screening, reducing the backlog of Veterans who are due for CRC screening, and ultimately reducing morbidity and mortality due to CRC. This innovation builds upon existing VHA resources and offers a highly cost-efficient approach that also reduces burden on front-line clinicians who are struggling to address care needs of Veterans during the pandemic. The developers of this intervention have created incredibly useful tools for educating Veterans and making it easy for them to participate in screening. This innovation should be adopted enterprise wide - ideally coordinated at the VISN level!