Legislative Changes

Legislation can be an important way both to generate interest in a particular trial and to sustain its impacts.  At the onset of the Strategies and Opportunities to Stop Colorectal Cancer (STOP CRC) in Priority Populations trial, colorectal cancer screening was adopted as an incentive metric for Oregon’s Coordinated Care Organizations (CCOs, the Oregon equivalent of Accountable Care Organizations). This meant that Medicaid Health Plans and CCOs would receive incentives for reaching performance or improvement targets for colorectal cancer screening. The initial performance target was set at 47%, and the improvement target was set at 3%. Over the subsequent years, additional state legislation was passed to reduce patient out-of-pocket costs for colorectal cancer screening. In 2014, passed legislation required that a colonoscopy initiated as a screening procedure be billed as a screening procedure—even when polyps were removed. Legislation passed in 2015 further required payers to cover the cost of a follow-up colonoscopy (with no out-of-pocket costs) among patients who screened positive on fecal testing.

Case Example: STOP CRC

  • STOP CRC improves the rates of colorectal-cancer screening by mailing fecal immunochemical testing kits to patients at Federally Qualified Health Centers. STOP CRC has explored facilitators for use (e.g., making it more user-friendly by using wordless instructions). Clinics also used planned-do-study-act (PDSA) cycles for exploring additional implementation strategies (e.g., improving workflow for printing and mailing kits and enhancements to patient materials).
Strategy Details
Diffusion Electronic health record tools and training videos are available to all health systems affiliated with OCHIN (100+ health systems across 18 states). Study materials (introductory letters, FIT kit inserts, reminder letters) are available on a public website.
Dissemination Publications and presentations (55 presentations at regional and national venues;15 publications to-date). Dr. Coronado offers technical assistance to additional Federally Qualified Health Centers as part of contracts with the Washington State Department of Health and the Oregon Health Authority.
Implementation A toolkit will be made publically available in 2017. The project adapted and rolled out the electronic health record tools, developed in Epic, into Allscripts.
Sustainability Control clinics were able to implement the mailed interventions in year 2. Partnerships with health plans and direct-mail vendors assist smaller health care centers to implement the mailed program. Oregon State passed legislation making it mandatory for most health plans to fully cover diagnostic colonoscopy after positive screening FIT tests.




Zatzick D, Tuzzio L, Chambers D, et al. Dissemination and Implementation: Legislative Changes. In: Rethinking Clinical Trials: A Living Textbook of Pragmatic Clinical Trials. Bethesda, MD: NIH Health Care Systems Research Collaboratory. Available at: http://rethinkingclinicaltrials.org/dissemination-implementation-top/legislative-changes/. Updated August 18, 2017.