Providers of patients in both arms of the study will be given an educational module about recent data on the benefits and harms of screening how these data fit in with existing population-centered guidelines.

The clinical reminder system will be modified so to facilitate documentation of informed decision making about CRC screening, including specific reasons for not screening. Additionally, providers who indicate a specific exception for not screening (using the modified clinical reminder) will be considered as satisfying the requirements and will not be penalized in terms of performance pay, and will be removed from feedback reports that encourage population screening.

A simple informational booklet explaining colorectal cancer screening and current screening recommendations.

Screening test completion was collected through manual review of electronic medical records.

Patients of primary care providers randomly assigned to the pragmatic control which included 1) a simple booklet in place of the decision aid; 2) modified performance measure/reminder; and, 3) provider education.

1. A simple informational booklet explaining colorectal cancer (CRC) screening and current screening recommendations.
2. The clinical reminder system was modified to facilitate documentation of informed decision making about CRC screening, including specific reasons for not screening. Providers who indicated a specific exception for not screening a patient were considered as satisfying the requirements and were not penalized in terms of performance pay. Additionally, the patient was removed from provider feedback reports that encourage population screening.
3. Providers were given information about recent data on the benefits and harms of screening & how these data fit in with existing population-centered guidelines.

Total of all reporting groups

Data were collected from electronic administrative health record information.

Self-reported race via survey.

Mailing address was collected via electronic administrative health record data.

Data were collected from electronic administrative health record information.

Categorized distribution of screening benefit. Screening benefit is defined as colorectal cancers prevented per 1,000 patients screened.

To create this subject-specific measure, we used a previously published simulation model to estimate the benefit of screening for individual patients according to age, prior screening, sex, and comorbidity.

Mean screening benefit is defined as colorectal cancers prevented per 1,000 patients screened.

To create this subject-specific measure, we used a previously published simulation model to estimate the benefit of screening for individual patients according to age, prior screening, sex, and comorbidity.

Current marital status; self-report via survey

Highest level of education obtained; self-report via survey

Patients of primary care providers randomly assigned to the pragmatic control which included 1) a simple booklet in place of the decision aid; 2) modified performance measure/reminder; and, 3)provider education.

1. A simple informational booklet explaining colorectal cancer (CRC) screening and current screening recommendations.
2. The clinical reminder system was modified to facilitate documentation of informed decision making about CRC screening, including specific reasons for not screening. Providers who indicated a specific exception for not screening a patient were considered as satisfying the requirements and were not penalized in terms of performance pay. Additionally, the patient was removed from provider feedback reports that encourage population screening.
3. Providers were given information about recent data on the benefits and harms of screening & how these data fit in with existing population-centered guidelines.

Defined as the degree to which screening orders align with expected screening benefit, such that individuals with low screening benefit receive screening orders at a lower rate than those with high screening benefit.

We hypothesized that Veterans randomized to the intervention (decision aid) would receive screening orders that were more concordant with screening benefit than those randomized to the control. The expected benefit of screening (reduction in CRC incidence) was calculated using the MISCAN-Colon model. For a given patient, this value was a function of age, gender, health status, and prior screening history. The regression analysis included screening orders as the dependent variable, and, study arm, expected benefit, and an interaction term between study arm and expected benefit as the independent variables. The p-value reported is for the interaction term.

Screening test completion was collected through manual review of electronic medical records.

Patients of primary care providers randomly assigned to the pragmatic control which included 1) a simple booklet in place of the decision aid; 2) modified performance measure/reminder; and, 3)provider education.

1. A simple informational booklet explaining colorectal cancer (CRC) screening and current screening recommendations.
2. The clinical reminder system was modified to facilitate documentation of informed decision making about CRC screening, including specific reasons for not screening. Providers who indicated a specific exception for not screening a patient were considered as satisfying the requirements and were not penalized in terms of performance pay. Additionally, the patient was removed from provider feedback reports that encourage population screening.
3. Providers were given information about recent data on the benefits and harms of screening & how these data fit in with existing population-centered guidelines.