Outreach and inreach organized service screening programs for colorectal cancer

Chu Kuang Chou, Sam Li Sheng Chen, Amy Ming Fang Yen, Sherry Yueh Hsia Chiu, Jean Ching Yuan Fann, Han Mo Chiu, Shu Lin Chuang, Tsung Hsien Chiang, Ming Shiang Wu, Chien Yuan Wu, Shu Li Chia, Yi Chia Lee, Shu Ti Chiou, Hsiu Hsi Chen

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Outreach (i.e., to invite those who do not use, or who under use screening services) and inreach (i.e., to invite an existing population who have already accessed the medical system) approaches may influence people to increase their use of screening test; however, whether their outcomes would be equivalent remains unclear. Methods: A total of 3,363,896 subjects, 50-69 years of age, participated in a colorectal cancer (CRC) screening program using biennial fecal immunochemical tests; 34.5% participated during 2004-2009 when the outreach approach alone was used, and 65.5% participated from 2010-2013 when outreach was integrated with an inreach approach. We compared the outcomes of the two approaches in delivery of screening services. Results: Coverage rates increased from 21.4% to 36.9% and the positivity rate increased from 4.0% to 7.9%, while referral for confirmatory diagnostic examinations declined from 80.0% to 53.3%. The first period detected CRC in 0.20% of subjects screened, with a positive predictive value (PPV) of 6.1%, and the second detected CRC in 0.34% of subjects, with a PPV of 8.0%. After adjusting for confounders, differences were observed in the PPV for CRC (adjusted relative risk, 1.50; 95% confidence interval [CI], 1.41-1.60), cancer detection rate (1.20; 95% CI, 1.13-1.27), and interval cancer rate (0.72; 95% CI, 0.65-0.80). When we focused on the comparison between two approaches during the same study period of 2010-2013, the positivity rate of fecal testing (8.2% vs. 7.6%) and the PPV for CRC detection remained higher (1.07; 95% CI, 1.01-1.12) in subjects who were recruited from the inreach approach. Conclusions: Outcomes of screening were equivalent or better after integration of outreach and inreach approaches. Impact: The results will encourage makers of health-care policy to adopt the integration approach to deliver screening services.

Original languageEnglish
Article numbere0155276
JournalPLoS One
Volume11
Issue number5
DOIs
Publication statusPublished - May 1 2016

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outreach
colorectal neoplasms
Colorectal Neoplasms
Screening
screening
confidence interval
Confidence Intervals
Health Policy
neoplasms
Early Detection of Cancer
relative risk
Neoplasms
Health care
Referral and Consultation
health services
Delivery of Health Care
testing
Population
Testing

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Outreach and inreach organized service screening programs for colorectal cancer. / Chou, Chu Kuang; Chen, Sam Li Sheng; Yen, Amy Ming Fang; Chiu, Sherry Yueh Hsia; Fann, Jean Ching Yuan; Chiu, Han Mo; Chuang, Shu Lin; Chiang, Tsung Hsien; Wu, Ming Shiang; Wu, Chien Yuan; Chia, Shu Li; Lee, Yi Chia; Chiou, Shu Ti; Chen, Hsiu Hsi.

In: PLoS One, Vol. 11, No. 5, e0155276, 01.05.2016.

Research output: Contribution to journalArticle

Chou, CK, Chen, SLS, Yen, AMF, Chiu, SYH, Fann, JCY, Chiu, HM, Chuang, SL, Chiang, TH, Wu, MS, Wu, CY, Chia, SL, Lee, YC, Chiou, ST & Chen, HH 2016, 'Outreach and inreach organized service screening programs for colorectal cancer', PLoS One, vol. 11, no. 5, e0155276. https://doi.org/10.1371/journal.pone.0155276
Chou, Chu Kuang ; Chen, Sam Li Sheng ; Yen, Amy Ming Fang ; Chiu, Sherry Yueh Hsia ; Fann, Jean Ching Yuan ; Chiu, Han Mo ; Chuang, Shu Lin ; Chiang, Tsung Hsien ; Wu, Ming Shiang ; Wu, Chien Yuan ; Chia, Shu Li ; Lee, Yi Chia ; Chiou, Shu Ti ; Chen, Hsiu Hsi. / Outreach and inreach organized service screening programs for colorectal cancer. In: PLoS One. 2016 ; Vol. 11, No. 5.
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abstract = "Background: Outreach (i.e., to invite those who do not use, or who under use screening services) and inreach (i.e., to invite an existing population who have already accessed the medical system) approaches may influence people to increase their use of screening test; however, whether their outcomes would be equivalent remains unclear. Methods: A total of 3,363,896 subjects, 50-69 years of age, participated in a colorectal cancer (CRC) screening program using biennial fecal immunochemical tests; 34.5{\%} participated during 2004-2009 when the outreach approach alone was used, and 65.5{\%} participated from 2010-2013 when outreach was integrated with an inreach approach. We compared the outcomes of the two approaches in delivery of screening services. Results: Coverage rates increased from 21.4{\%} to 36.9{\%} and the positivity rate increased from 4.0{\%} to 7.9{\%}, while referral for confirmatory diagnostic examinations declined from 80.0{\%} to 53.3{\%}. The first period detected CRC in 0.20{\%} of subjects screened, with a positive predictive value (PPV) of 6.1{\%}, and the second detected CRC in 0.34{\%} of subjects, with a PPV of 8.0{\%}. After adjusting for confounders, differences were observed in the PPV for CRC (adjusted relative risk, 1.50; 95{\%} confidence interval [CI], 1.41-1.60), cancer detection rate (1.20; 95{\%} CI, 1.13-1.27), and interval cancer rate (0.72; 95{\%} CI, 0.65-0.80). When we focused on the comparison between two approaches during the same study period of 2010-2013, the positivity rate of fecal testing (8.2{\%} vs. 7.6{\%}) and the PPV for CRC detection remained higher (1.07; 95{\%} CI, 1.01-1.12) in subjects who were recruited from the inreach approach. Conclusions: Outcomes of screening were equivalent or better after integration of outreach and inreach approaches. Impact: The results will encourage makers of health-care policy to adopt the integration approach to deliver screening services.",
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AU - Chen, Sam Li Sheng

AU - Yen, Amy Ming Fang

AU - Chiu, Sherry Yueh Hsia

AU - Fann, Jean Ching Yuan

AU - Chiu, Han Mo

AU - Chuang, Shu Lin

AU - Chiang, Tsung Hsien

AU - Wu, Ming Shiang

AU - Wu, Chien Yuan

AU - Chia, Shu Li

AU - Lee, Yi Chia

AU - Chiou, Shu Ti

AU - Chen, Hsiu Hsi

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N2 - Background: Outreach (i.e., to invite those who do not use, or who under use screening services) and inreach (i.e., to invite an existing population who have already accessed the medical system) approaches may influence people to increase their use of screening test; however, whether their outcomes would be equivalent remains unclear. Methods: A total of 3,363,896 subjects, 50-69 years of age, participated in a colorectal cancer (CRC) screening program using biennial fecal immunochemical tests; 34.5% participated during 2004-2009 when the outreach approach alone was used, and 65.5% participated from 2010-2013 when outreach was integrated with an inreach approach. We compared the outcomes of the two approaches in delivery of screening services. Results: Coverage rates increased from 21.4% to 36.9% and the positivity rate increased from 4.0% to 7.9%, while referral for confirmatory diagnostic examinations declined from 80.0% to 53.3%. The first period detected CRC in 0.20% of subjects screened, with a positive predictive value (PPV) of 6.1%, and the second detected CRC in 0.34% of subjects, with a PPV of 8.0%. After adjusting for confounders, differences were observed in the PPV for CRC (adjusted relative risk, 1.50; 95% confidence interval [CI], 1.41-1.60), cancer detection rate (1.20; 95% CI, 1.13-1.27), and interval cancer rate (0.72; 95% CI, 0.65-0.80). When we focused on the comparison between two approaches during the same study period of 2010-2013, the positivity rate of fecal testing (8.2% vs. 7.6%) and the PPV for CRC detection remained higher (1.07; 95% CI, 1.01-1.12) in subjects who were recruited from the inreach approach. Conclusions: Outcomes of screening were equivalent or better after integration of outreach and inreach approaches. Impact: The results will encourage makers of health-care policy to adopt the integration approach to deliver screening services.

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