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
- 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.
Develop written agreements with referral services or specialists to coordinate follow-up care.
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]
- 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.
Educate patients regarding genetic risk and communication with family members.
Refer patients and family members for genetic counseling and testing when appropriate.
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.