{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:56:14Z","timestamp":1792799774899,"version":"4.5.0"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"14","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,10,10]]},"abstract":"\n Importance<\/jats:title>\n Realizing the benefits of cancer screening requires testing of eligible individuals and processes to ensure follow-up of abnormal results.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To test interventions to improve timely follow-up of overdue abnormal breast, cervical, colorectal, and lung cancer screening results.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Pragmatic, cluster randomized clinical trial conducted at 44 primary care practices within 3 health networks in the US enrolling patients with at least 1 abnormal cancer screening test result not yet followed up between August 24, 2020, and December 13, 2021.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Automated algorithms developed using data from electronic health records (EHRs) recommended follow-up actions and times for abnormal screening results. Primary care practices were randomized in a 1:1:1:1 ratio to (1) usual care, (2) EHR reminders, (3) EHR reminders and outreach (a patient letter was sent at week 2 and a phone call at week 4), or (4) EHR reminders, outreach, and navigation (a patient letter was sent at week 2 and a navigator outreach phone call at week 4). Patients, physicians, and practices were unblinded to treatment assignment.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was completion of recommended follow-up within 120 days of study enrollment. The secondary outcomes included completion of recommended follow-up within 240 days of enrollment and completion of recommended follow-up within 120 days and 240 days for specific cancer types and levels of risk.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 11\u202f980 patients (median age, 60 years [IQR, 52-69 years]; 64.8% were women; 83.3% were White; and 15.4% were insured through Medicaid) with an abnormal cancer screening test result for colorectal cancer (8245 patients [69%]), cervical cancer (2596 patients [22%]), breast cancer (1005 patients [8%]), or lung cancer (134 patients [1%]) and abnormal test results categorized as low risk (6082 patients [51%]), medium risk (3712 patients [31%]), or high risk (2186 patients [18%]), the adjusted proportion who completed recommended follow-up within 120 days was 31.4% in the EHR reminders, outreach, and navigation group (n\u2009=\u20093455), 31.0% in the EHR reminders and outreach group (n\u2009=\u20092569), 22.7% in the EHR reminders group (n\u2009=\u20093254), and 22.9% in the usual care group (n\u2009=\u20092702) (adjusted absolute difference for comparison of EHR reminders, outreach, and navigation group vs usual care, 8.5% [95% CI, 4.8%-12.0%],\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). The secondary outcomes showed similar results for completion of recommended follow-up within 240 days and by subgroups for cancer type and level of risk for the abnormal screening result.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n A multilevel primary care intervention that included EHR reminders and patient outreach with or without patient navigation improved timely follow-up of overdue abnormal cancer screening test results for breast, cervical, colorectal, and lung cancer.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03979495<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2023.18755","type":"journal-article","created":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T11:01:50Z","timestamp":1696935710000},"page":"1348","source":"Crossref","is-referenced-by-count":45,"title":["A Multilevel Primary Care Intervention to Improve Follow-Up of Overdue Abnormal Cancer Screening Test Results"],"prefix":"10.1001","volume":"330","author":[{"given":"Steven J.","family":"Atlas","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna N. 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