# Colorectal Screening Outreach Operating Checklist

This checklist is for population health, quality, and value-based care teams redesigning colorectal cancer screening outreach. It is built around the operating lesson from Jefferson's FIT/iFOBT redesign: completion, cadence, reminders, instructions, and staff burden are part of the intervention.

## 1. Define The Screening Population

- Confirm age range and guideline basis.
- Exclude patients already screened within the appropriate interval.
- Exclude patients with clinical contraindications or diagnostic follow-up needs.
- Separate average-risk screening from higher-risk surveillance.
- Define the source of truth for the denominator.
- Decide how often denominator logic will refresh.

## 2. Define Completion Correctly

Use resulted test as the primary completion outcome.

Do not treat these as completion:

- kit ordered
- kit mailed
- MyChart message sent
- letter sent
- patient reached
- patient verbally agreed
- referral placed

## 3. Compare The Full Pathway

For each pathway, document:

| Pathway | Interval | Patient Work | Staff Work | Vendor Work | Main Failure Point |
| --- | --- | --- | --- | --- | --- |
| FIT / iFOBT | Annual | | | | |
| Cologuard / mt-sDNA | Usually 3 years when negative | | | | |
| Colonoscopy | Longer interval when normal | | | | |

## 4. Redesign FIT / iFOBT Materials

- Rewrite the MyChart message around one clear next action.
- Rewrite the letter with plain-language instructions.
- Include what the kit is, why it matters, and what to do next.
- Add QR code access to a short tutorial video when available.
- Use branded envelopes or recognizable mailed materials.
- Make support contact options obvious.
- Avoid overloading the patient with clinical detail before the action is clear.

## 5. Build Reminder Cadence

Define the sequence before launch:

- initial outreach
- first reminder
- second reminder
- mailed reminder if needed
- phone follow-up if appropriate
- final closeout or requeue logic

Track which reminders actually change completion.

## 6. Track Staff Burden

Measure:

- outreach touches per completed screen
- staff time per completed screen
- calls per completed screen
- messages per completed screen
- letters per completed screen
- returned, expired, invalid, or incomplete kits
- follow-up needed after positive results

## 7. Avoid Bad Claims

Do not claim:

- lives saved
- cancers prevented
- stage shift
- payer savings
- total cost reduction

unless you have approved data for those outcomes.

Safer claims:

- resulted-test completion
- reminder cadence
- staff burden
- repeat-screening cadence
- outreach volume
- diagnostic follow-up after positive screen

## 8. Review The Financing Reality

Ask:

- Who pays for the test?
- Who benefits if cancer is prevented years later?
- What is the expected member churn?
- Does the payer capture downstream savings?
- Does the health system have a longer-term population-health rationale?
- Does the program still make sense if only completion is measured?

## 9. Final Launch Checklist

- Denominator locked.
- Completion definition approved.
- MyChart copy approved.
- Letter copy approved.
- QR tutorial link tested.
- Reminder cadence documented.
- Staff workflow documented.
- Metrics dashboard reviewed.
- Sensitivity and public claims reviewed.
- Positive-screen follow-up logic confirmed.