LAUSR

Introduction: Colorectal cancer (CRC) is a common but largely preventable disease with suboptimal screening rates despite national guidelines to screen individuals age 50–75. Single‐component interventions aimed to improve screening uptake only modestly improve rates; data suggest that multi‐modal approaches may be more effective. Methods: We designed, implemented, and evaluated the impact of a multi‐modal intervention on CRC screening uptake among unscreened patients in a large managed care population. Patient‐level components included a mailed letter with education about screening options and pre‐colonoscopy telephone counseling. For providers, we facilitated communication of screening test results and work‐flow for abnormal results. System‐level modifications included establishment of a patient navigator, expedited work‐up for abnormal results, and stream‐lined colonoscopy scheduling. We measured the rate of screening uptake overall, screening uptake by modality, change in the proportion of the population screened, and positive fecal immunochemical test (FIT) follow‐up rates in the 1‐year study period. Results: There were 5093 patients in the intervention cohort. Of these, 33.2% participated in FIT or colonoscopy screening within 1 year of the mailing. A total of 1078 (21.2%) participants completed a FIT and 611 (12.0%) completed a screening colonoscopy. The screening rate in the managed care population increased from 65.1 to 76.6%. Fifty‐nine patients (5.5%) had a positive FIT, of which 30 (50.8%) completed a diagnostic colonoscopy. Conclusion: Multi‐modal interventions can result in substantial improvement in CRC screening uptake in large and diverse managed care populations. Translational Impact: Health systems should shift their focus from single‐level to multi‐level interventions when addressing barriers to CRC screening.