Focus Area: Follow-up and Referral for Additional Testing and Treatment
Colorectal Cancer Screening Change Package
The follow-up and referral focus area includes tools and resources to—
- Promote and support regular screening per USPSTF recommendations.
- Ensure timely referral for diagnostic testing, treatment, and other appropriate next steps, such as genetic testing, when screening tests are abnormal.
- Change concepts are “general notions that are useful for developing more specific strategies for changing a process.”1
- Change ideas are evidence-based or practice-based “actionable, specific ideas or strategies.”1
- Each change idea is linked to tools and resources that can be used or adapted to improve cancer screening.
Notes
- Tools and resources with a symbol may contain some information that does not reflect the current US Preventive Services Task Force (USPSTF) recommendations for colorectal cancer screening.
- Tools and resources with a symbol are patient resources.
See a list of acronyms used in this change package.
Change Concepts
- Establish relationships with specialists for diagnostic testing and treatment.
- Adopt policies and procedures for patient referral and follow-up for diagnostic testing and treatment.
- Overcome barriers to follow-up and treatment.
- Facilitate genetic screening for patients and their relatives.
- Implement follow-up processes for regular screening.
Change Concept: Establish relationships with specialists for diagnostic testing and treatment.
Tools and Resources, by Change Idea
Identify and partner with referral services or specialists who can provide follow-up diagnostic tests and/or cancer screening.
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide [PDF-3MB], pages 25-26
- IOM — Primary Care and Public Health: Exploring Integration to Improve Population Health
- Illinois Colon CARES (Cancer Alliance to Reignite and Enhance Screening) — Illinois Colon CARES
- NACHC — Value Transformation Framework: Cancer Screening [PDF-618KB], pages 9–10
- Nekhlyudov L, Latosinsky S, 2010 — The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis
Establish two-way communication with referral services or specialists to find out if patients followed up with referrals.
- AHRQ — Coordinating Care in the Medical Neighborhood: Critical Components and Available Mechanisms [PDF-715KB]
- Illinois Colon CARES (Cancer Alliance to Reignite and Enhance Screening) — Illinois Colon CARES
- Nekhlyudov L, Latosinsky S, 2010 — The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis
Develop written agreements with referral services or specialists to coordinate follow-up care.
- NCCRT and ACS — Steps for Increasing Colorectal Cancer Screening Rates: A Manual for Community Health Centers [PDF-7.6MB], pages 39–41 and 104
Change Concept: Adopt policies and procedures for patient referral and follow-up for diagnostic testing and treatment.
Tools and Resources, by Change Idea
Develop protocols and workflows, such as reminder systems, to ensure follow-up referrals are made.
- AICAF and NIHB — Advancing Health Systems Toolkit [PDF-23.6MB], pages 12 and 15
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide [PDF-3MB], pages 26, 39
- Evidence-Based Cancer Control Programs (EBCPP) — Fecal Immunochemical Test and Colonoscopy Outreach — Colonoscopy Strategy Workflow
- Kaiser Permanente CHR — Health Plan: Clinic Workflow for Unestablished Patient (When FIT Results Arrive) [PDF-398KB]
- NCCRT — Reigniting Colorectal Cancer Screening as Communities Face and Respond to the COVID-19 Pandemic [PDF-1.9MB] [webinar], slides 27–28
- Nekhlyudov L, Latosinsky S, 2010 — The Interface of Primary and Oncology Specialty Care: From Symptoms to Diagnosis
Implement best practices for notification of abnormal test results and follow-up instructions to the patient.
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide [PDF-3MB], pages 26, 39
- Evidence-Based Cancer Control Programs – Against Colorectal Cancer In Our Neighborhoods (ACCION) — FIT Abnormal Results Letter [PDF-194KB] [English and Spanish]
- Evidence-Based Cancer Control Programs – Against Colorectal Cancer In Our Neighborhoods (ACCION) — FIT Positive Results Letter [PDF-62KB] [English and Spanish]
- NCCRT and ACS — How to Assure Follow Up Colonoscopy for Positive FIT from the Process Side
- ONC — SAFER: Self-Assessment Test Results Reporting and Follow-Up [PDF-3.6MB], pages 5–7
Create a tracking system for documenting patient follow-up after an abnormal test result.
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide [PDF-3MB], pages 9–10, 26, and 35
- ECRI on behalf of HRSA — Using the EHR for Care Management and Tracking [PDF-696KB]
- Evidence-Based Cancer Control Programs (EBCCP) — Smart Options for Screening (SOS), see Program Materials: SOS Quality Assurance for Positive FOBT-FIT
Use EHR-based clinical decision management tools to guide follow-up care.
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide [PDF-3MB], page 9
- ECRI on behalf of HRSA — Using the EHR for Care Management and Tracking [PDF-696KB]
Change Concept: Overcome barriers to follow-up and treatment.
Tools and Resources, by Change Idea
Work with specialists and health care facilities to negotiate free or reduced-cost follow-up services or offer payment plans for patients experiencing financial disadvantage.
Identify sources for low-cost or free transportation services for follow-up care.
- ACS — Road to Recovery [English and Spanish]
- AHA — Social Determinants of Health: Transportation and the Role of Hospitals [PDF-2.6MB]
- CMS — Non-Emergency Medical Transportation (NEMT)
- Livestrong — Transportation and Other Cancer Support Resources
Offer same-day and open-access scheduling and services outside of traditional hours.
- The Community Guide — Cancer Screening: Reducing Structural Barriers for Clients – Cervical Cancer
Use patient navigation to help individuals access follow-up services.
Change Concept: Facilitate genetic screening for patients and their relatives.
Tools and Resources, by Change Idea
Implement risk assessment tools such as family histories and genetic counseling tools during primary care visits.
- NCCRT, ACS, and The Jackson Laboratory — Risk Assessment and Screening Toolkit to Detect Familial, Hereditary, and Early Onset Colorectal Cancer [PDF-1.5MB]
Educate patients regarding genetic risk and communication with family members.
- CDC — Hereditary Colorectal (Colon) Cancer
- NCCRT, ACS, and The Jackson Laboratory — Risk Assessment and Screening Toolkit to Detect Familial, Hereditary, and Early Onset Colorectal Cancer [PDF-1.5MB], pages 39, 56 and 58
Refer patients and family members for genetic counseling and testing when appropriate.
- NCCRT, ACS, and The Jackson Laboratory — Risk Assessment and Screening Toolkit to Detect Familial, Hereditary, and Early Onset Colorectal Cancer [PDF-1.5MB], pages 34 and 60
Change Concept: Implement follow-up processes for regular screening.
Tools and Resources, by Change Idea
Provide visit summaries and patient education on future regular screening.
- CDC, NACDD, and Kaiser Permanente CHR — Mailed FIT Implementation Guide [PDF-3MB], page 39
- Evidence-Based Cancer Control Programs – Against Colorectal Cancer In Our Neighborhoods (ACCION) — FIT Normal Results Letter [PDF-188KB] [English and Spanish]
Reference
1Centers for Disease Control and Prevention. Tobacco Cessation Change Package. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2019.