Improving Colorectal Cancer Screening in NC Medicaid Beneficiaries

Colorectal cancer (CRC) screening in North Carolina is underutilized, particularly among those with low income and less education. Medicaid recipients have lower colon cancer screening rates than other insured populations, despite Medicaid's coverage of CRC screening. Several interventions have been shown to be effective in increasing colon cancer screening, but the best combination of interventions has not been well-studied. Based on analysis of CRC screening data, the team has selected the Lower Cape Fear region as the area for its project. This study surveyed and worked with six of the region's medical practices from the Community Care of North Carolina (CCNC) program, which seeks to improve quality of care for Medicaid beneficiaries. The intervention combined mailing patient decision aids (DVD and written materials to help patients decide about colon cancer screening) and telephone-based assistance from a regional patient navigator to help overcome barriers to screening. The team examined its effects on screening test completion in 200 Medicaid beneficiaries from six practices within the selected CCNC region.

Findings: The study found that a mailed decision aid plus phone-based patient navigator intervention had limited use and was not able to increase colorectal screening compared with a control.  However, intervention participants who used the intervention were more likely to get screened than those who did not. High-intensity interventions, such as practice-based navigators, may be needed to better reach and improve screening rates among vulnerable populations.

Geographic area(s) served: Bladen & New Hanover Counties

Research team:
Michael Pignone, MD, MPH, professor of internal medicine, and Carmen Lewis, MD, MPH, associate professor of medicine (co-principal investigators); Annette DuBard, MD, MPH, director of informatics, quality, and evaluation at NC Community Care Networks Inc.; Cathy Melvin, PhD; Lucia Leone, PhD, postdoctoral fellow in cancer health disparities, nutrition.

For more information about this pilot research study, contact Dr. Lucia Leone at