Bright Spot: FLU-FIT and FLU-FOBT Program

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This bright spot was originally published in the 100 Million Healthier Lives Change Library and is brought to you through partnership with 100 Million Healthier Lives and the Institute for Healthcare Improvement.


Detailed Description

The Flu-FIT and Flu-FOBT Program allows health care providers to increase access to colorectal cancer screening (CRCS) by offering home tests to patients at the time of their annual influenza (flu) vaccination. The program is designed to increase CRCS rates by conveying the importance of screening and getting an annual flu shot. The message to patients is that "just like a flu shot, you need FIT or FOBT every year." Nurses or medical assistants are provided a variety of tools to assist with offering a home FIT or FOBT kit to eligible patients, including visual aids for explaining the test to patients (including foods to avoid to prevent false positive results), simple written instructions for how to self-administer the test, video instructions, and stamped envelopes for completing and returning the kit to the laboratory. These materials are provided in English, Cantonese, Mandarin, Russian, Spanish, and Vietnamese. Nurses are encouraged to use whichever materials they find most useful to encourage patients to complete FIT or FOBT. The Flu-FIT and Flu-FOBT Program is designed for patients aged 50-75 years who are both due for CRCS and receive annual flu shots during primary care visits or at drop-in flu shot clinics. Patients are considered due for CRCS if they have not had one of the following: FOBT or FIT in the past year, a flexible sigmoidoscopy in the past 5 years, or a colonoscopy in the past 10 years.

Expected Outcomes

The expected outcome is an increase in colorectal cancer screening rates in all populations.

Cost Details

In most cases, FLU-FIT and FLU-FOBT Programs require relatively few resources and are inexpensive to implement. Setting up a system to bill insurance plans for FIT and FOBT may offset some of the costs of the program. For costs associated with the program, please contact- Michael Potter, MD Department of Family and community Medicine University of California, San Francisco, San Francisco, CA 94143-0900 Email: [email protected]

Key Steps for Implementation

The key steps are:

  • Put together a FLU-FIT or FLU-FOBT Team
  • Select a FLU-FIT or FLU-FOBT Champion to coordinate your efforts
  • Select FLU-FIT or FLU-FOBT Team Members and Staffing Levels
  • Choose times and places for FLU-FIT or FLU-FOBT and advertise them
  • Patient Flow and Line Management Plan|Offer FIT/FOBT in line BEFORE giving the flu shot
  • Assessing eligibility for FLU and FIT/FOBT
  • Develop systems to support follow-Up of FIT/FOBT kits dispensed. The intervention takes just a few minutes per patient and is implemented concurrently at seasonal flu vaccination clinics. One to 2 hours of staff training are required initially, with periodic brief review and reinforcement of program procedures and progress by a practice team leader or supervisor during the intervention.

Required Staffing (FTEs)

To implement a FLU-FIT or FLU-FOBT process, there may be a need to adjust staffing levels. If it is a high volume clinical site, there may be a need to assign one or more additional persons above what is usually need for flu shot season to help assess patient eligibility and dispense FIT kits. Depending on the setup, each team member may carry out all aspects of the FLU-FIT or FLU-FOBT process with patients|or the tasks can be divided. A nurse or other member of the medical team who works closely with the manager of the clinical site can act as a program coordinator.

Special Infrastructure

The Flu-FIT and Flu-FOBT Program can be implemented in community health centers, pharmacies, managed care organizations, and other health care settings where flu shots are provided and where FIT or FOBT is offered for average-risk colorectal cancer screening. To be successful, health care organizations offering Flu-FIT and Flu-FOBT Programs must be able to assure follow up of abnormal FIT or FOBT tests with diagnostic colonoscopy.

Required resources to implement the program include the following:

  • Mailed FLU-FIT and FLU-FOBT announcements
  • Clinic posters to advertise the program
  • Algorithms for patient flow and for using electronic medical records to assess FIT or FOBT eligibility
  • Script to introduce/explain FIT or FOBT with flu shots to patients
  • Visual aids to use when offering FIT or FOBT to patients
  • Multilingual materials to explain why colorectal cancer screening is important, completion instructions, and video instructions
  • Pre-addressed and pre-stamped mailing pouches Log sheet to record flu shots and kits dispensed
  • Clinic nursing staff Flu shots and FIT/FOBT Kits with Return Envelopes/Stamps. Downloadable, customizable versions of most of the required materials, as well as staff training slides and video demonstrations of how to use them, are available through the program website


Setting up a FLU-FIT or FLU-FOBT Program requires staff training. The 5 key elements to include in the training should include:

  1. Information about the importance of both flu shots and colorectal cancer screening.
  2. Information about how to organize your workflow efficiently.
  3. Assessing eligibility for flu shots and for FIT or FOBT without waiting for a doctor;s order.
  4. Talking to patients about FIT or FOBT and how to complete the test.
  5. Information about how to record their work and provide follow-up of FIT or FOBT kits provided to patients.

Types of Staff

FLU-FIT and FLU-FOBT team members can be medical assistants or other health workers who enjoy working with patients and who can be trained to provide flu shots and/or FIT/FOBT kits to patients.

Outcome Measures

The primary outcome is the change in CRC screening rates.

Process Measures

  • Flu shots and FIT/FOBT kits dispensed
  • FOBT completion rate (mailed kits, postcards and phone call reminders)
  • Results follow-up (follow-up appointment and colonoscopy)

Program Theory Documents

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