A mailed fecal immunochemical test (FIT) outreach intervention significantly raised rates of FIT completion and rates of any colorectal cancer (CRC) screening, a new study found. The cluster randomized clinical trial was conducted in 26 federally qualified health clinics. All participants were overdue for CRC screening during the accrual interval. Electronic health record (EHR)-embedded tools were used to identify eligible adults and to facilitate implementation of a stepwise mailed intervention involving 1) an introductory letter, 2) a mailed FIT, and 3) a reminder letter; training, collaborative learning, and facilitation through a practice improvement process. Effectiveness was measured as clinic-level proportions of adults who completed a FIT, and secondarily, any CRC screening within 12 months of accrual. Researchers found:

• 26 clinics with 41,193 adults (mean age 58.5 years) were randomized to receive the direct mail colorectal screening intervention (13 clinics; 21,134 patients) or usual care (13 clinics; 20,059 patients).
• Compared with usual care clinics, intervention clinics had significantly higher adjusted clinic-level proportion of participants who completed a FIT and any CRC screening.
• A large variation across health centers in effectiveness was observed.