Acute respiratory tract infections (ARTIs) are among the most common reasons for pediatric primary care visits and antibiotic receipt. Telemedicine outside of primary care settings has been associated with overuse of antibiotics for ARTIs in children. The quality of telemedicine when integrated within primary care for children is not clear. To compare antibiotic management during primary care visits conducted through telemedicine vs in-person. This retrospective, cross-sectional study analyzed visits for ARTIs in children younger than 18 years between January 1 and December 31, 2023, at 694 US primary care practices (including community health organizations, independent pediatric practices, and practice networks affiliated with large health systems). Analyses were performed between October 1, 2024, and February 12, 2026. Primary care telemedicine vs primary care in-person index visits. The primary outcomes were percentage of index visits with antibiotics prescribed and percentage with antibiotic management concordant with guidelines for visit diagnosis. Secondary outcomes included index visit diagnosis, follow-up visits within 14 days, and antibiotic prescription within 14 days. Weighted analyses were conducted using a propensity score model to estimate the probability of an ARTI index visit being conducted via telemedicine and estimated the average treatment effect associated with telemedicine. This study included 438 148 in-person and 11 482 telemedicine index ARTI visits at primary care practices by 302 817 children (mean [SD] age: 6.6 [4.7] years; 51.4% male). Antibiotic prescription occurred during 46.8% (95% CI, 45.1%-48.4%) of primary care in-person visits vs 34.6% (95% CI, 27.0%-42.3%) of primary care telemedicine visits in the propensity score-weighted model, with a difference of -12.1 (95% CI, -19.3 to -5.0) percentage points. Antibiotic management was guideline concordant for 86.2% (95% CI, 85.1%-87.3%) of primary care in-person visits vs 85.5% (95% CI, 80.5%-90.4%) of primary care telemedicine visits, with a difference of -0.7 (95% CI, -5.3 to 3.8) percentage points. The proportion of follow-up visits and antibiotic prescription within 14 days after initial visit did not vary significantly by index visit modality. In this cross-sectional study of primary care practices caring for children, telemedicine integrated within primary care was associated with judicious antibiotic prescribing without increased follow-up visits or subsequent antibiotics prescribed. Supporting primary care practices in offering telemedicine for acute concerns may be a strategy to limit unnecessary antibiotic receipt.
Primary care improves population health, yet access is a challenge in the US. It is unclear how primary care use, access, and access disparities have changed since widespread adoption of telemedicine during the pandemic. To quantify trends in primary care use and determine the role of telemedicine in primary care access and access disparities for traditional Medicare beneficiaries. Serial cross-sectional study using 2017-2023 100% claims and administrative data for traditional Medicare beneficiaries continuously enrolled and alive for the given year. Data were analyzed from October 2024 to July 2025. Primary care visits per beneficiary, primary care access (defined as ≥1 virtual or in-person primary care visit in the year), and primary care continuity (Bice-Boxerman Index). Among 258 324 127 person-years from 2017 to 2023, primary care visit rates decreased from 2.54 per person-year in 2017 to 2.27 per person-year in 2023, and access dropped from 61.9% to 59.8%. In 2023, virtual visits comprised 7% of primary care visits and 14% of beneficiaries who accessed primary care used telemedicine to do so. Disparities in access by race, geography, and income increased slightly from 2019 to 2023, and beneficiaries in historically underserved groups by race, geography, and income who accessed primary care were more likely than others to use telemedicine to do so. Primary care continuity decreased from 0.72 in 2019 to 0.65 in 2023; in 2023, continuity was slightly higher for those using telemedicine for primary care than for those who were not. This serial cross-sectional study found that across all traditional Medicare beneficiaries, primary care visit rates and access decreased, with virtual visits comprising a small share of previously in-person visits. Access disparities widened while those in underserved groups were more likely than others to use telemedicine for this access. Results suggest that telemedicine plays a small but potentially important role in primary care access.
Mentorship is foundational to the career development of academic physicians. During challenging times, mentees often look to their mentors for additional support and guidance; however, there are few empirical data on best practices for mentoring during times of crisis. To describe the best practices of award-winning research mentors during challenging times. Our exploratory qualitative study included in-depth interviews with mentors who were internal medicine faculty members and had received a clinical and translational research mentoring award between 2016 and 2024 at the University of Michigan Medical School. A semistructured interview guide was used, and interviews were conducted between July 14 and October 1, 2025, audio recorded, transcribed, and deidentified. Transcripts were analyzed through a descriptive content analysis approach and included both inductive and deductive coding. With the use of audio-recorded interviews, participant views were obtained on effective mentoring strategies in academic medicine focused on mentoring during the current climate of uncertainty related to research funding. In this qualitative study of 15 physician mentors (7 [46.7%] females; 8 [53.3%] males), key themes emerged from the qualitative data, organized into 3 domains: (1) tactical strategies mentors used during challenging times (eg, help mentees identify diverse funding sources, encourage consideration of alternative career options or areas of research focus), (2) psychological strategies used during challenging times (eg, provide emotional support, coach mentees' mindsets), and (3) overall mentoring philosophies and strategies for effective mentoring (eg, provide support and honest feedback, network on behalf of the mentee). This qualitative study of notable research mentors identified several strategies and philosophies that may be used to guide mentees during uncertain times. These approaches may transcend a specific crisis and be widely applicable during future challenging times in academic medicine.
This Clinical Insights summarizes the pharmacological characteristics of dalbavancin and oritavancin and evaluates the clinical evidence supporting their use in infections beyond acute bacterial skin and skin structure infections for general internal medicine clinicians.
Syringe services programs (SSPs) are evidence-based interventions that reduce bloodborne infections and injection-related harms among people who inject drugs, yet access remains limited and geographically uneven across the US. To quantify the travel time, distance, and cost required to reach the nearest SSP from population-weighted census tracts nationwide and to examine differences by urbanicity, state, and SSP legality. This cross-sectional geospatial study linked all known SSP locations as of August 2024 to the population-weighted centroids of census tracts in the 50 US states and the District of Columbia. Analyses were conducted between December 2024 and February 2026. Population-weighted mean and median driving time, distance, and cost to access the nearest SSP, stratified by National Center for Health Statistics urban-rural county category and SSP legal status. Costs were estimated using 2024 Internal Revenue Service (IRS) medical mileage deduction rates and 2022 state-specific gasoline prices. In 1338 SSPs across 83 780 census tracts, the population-weighted mean 1-way driving time to the nearest SSP was 46.1 minutes (95% CI, 45.7-46.5 minutes) and the median was 23.3 minutes (IQR, 12.2-58.5 minutes). Altogether, 23.1% of the population lived more than 60 minutes from an SSP and 12.6% lived over 120 minutes away. The mean 1-way driving distance was 41.8 miles (95% CI, 41.3-42.2 miles). The mean 1-way driving cost was $8.77 (95% CI, $8.68-$8.86) using the 2024 IRS mileage rate and $6.91 (95% CI, $6.84-$6.98) using state mean gasoline prices in 2022. In states where SSPs were legal, mean driving time was 30.1 minutes (95% CI, 29.8-30.4 minutes) and mean cost by IRS mileage rates was $4.94 (IQR, $4.88-$5.00), compared with 110.7 minutes (95% CI, 109.6-111.8 minutes) and $24.19 (IQR, $23.92-$24.46) in states where SSPs were illegal. This cross-sectional study of travel burden to SSPs found substantial geographic and financial barriers to accessing SSPs across the US, particularly in nonmetropolitan areas. Targeting new SSPs to areas with the greatest travel burden could improve utilization and reduce drug-related morbidity.
Pediatric hemovigilance is a nascent field in transfusion medicine. The lack of standardized hemovigilance reporting in the US makes it difficult to determine age-specific transfusion reaction rates and risks. To evaluate the rates and epidemiology of transfusion reactions reported to transfusion services in neonatal and pediatric populations. This cohort study analyzed transfusion reactions occurring in children younger than 18 years reported to 8 hospitals' transfusion services during April 1, 2019, through December 31, 2023. Data were evaluated from March 2024 to June 2025 using standardized data collection forms and associated electronic health records. Patients who received transfused blood products (red blood cells [RBCs], platelets, plasma, or cryoprecipitate) with at least 1 transfusion reaction reported to the transfusion service. Reaction rates per 100 000 products transfused were calculated. Pediatric transfusion reactions were characterized in detail, including reported severity and imputability; product type; patient age, sex, race, and ethnicity; and reported symptoms, premedication, and clinical management. The sample included 228 886 products transfused to 22 628 patients (median [IQR] age, 4.2 [0.3-12.4] years; 127 903 males [55.9%]). The products were transfused to patients of Asian (18 649 [8.2%]), Black (37 673 [16.5%]), White (93 824 [41.0%]), multiracial (3680 [1.6%]), other (68 857 [30.1%]), or unknown race (6203 [2.7%]) and Hispanic or Latinx (52 398 [22.9%]), non-Hispanic and non-Latinx (144 017 [62.9%]), and unknown ethnicity (32 471 [14.2%]). A total of 1165 imputable transfusion reactions were reported, with an overall reaction rate of 0.52% (95% CI, 0.49%-0.55%). Patients aged 5 to 11 years had the highest reported transfusion reaction rate (891.11 [95% CI, 799.81-989.11] per 100 000 products transfused). Platelet transfusions had the highest transfusion reaction rates (821.75 [95% CI, 754.14-893.80] per 100 000 products transfused), with allergic reactions being most common (506.04 [95% CI 453.30, 563.24] per 100 000 products transfused), whereas RBC transfusions had more reported febrile nonhemolytic transfusion reactions (FNHTRs; 296.20 [267.06, 327.67] per 100 000 products transfused) than other types of reactions. The most common symptoms were urticaria (69.6% [368 of 529 patients]) in allergic reactions, fever (96.5% [559 of 579 patients]) in FNHTRs, and acute respiratory distress (87.5% [21 of 24 patients]) in transfusion-associated circulatory overload (TACO); the most common treatments were antihistamines (80.3% [425 of 529 patients]) for allergic reactions, antipyretics (67.9% [393 of 579 patients]) for FNHTRs, and diuretics (83.3% [20 of 24 patients]) for TACO. Many patients (35.8% [107 of 299]) did not receive premedication after the first reaction in subsequent transfusions, regardless of reaction type. When transfusion reactions recurred, they were often of the same type (77.9% of reactions [120 of 154] after allergic reactions were allergic; 72.1% of reactions [98 of 136] after FNHTRs were FNHTRs). In this cohort study of pediatric transfusion reactions, reactions appeared to be age dependent, and rates of allergic reactions and FNHTRs were higher than rates from previously published, possibly underreported, predominantly adult data. These findings underscore the importance of pediatric-specific hemovigilance to improve recognition, reporting, and safety monitoring of transfusion reactions.
Prepregnancy care and counseling optimize maternal health before conception to improve outcomes for mothers and infants. In the US, 66.4% of reproductive-aged women have at least 1 modifiable risk factor for adverse pregnancy outcomes. For all individuals desiring pregnancy, recommended interventions include folic acid supplementation; cessation of tobacco, alcohol, cannabis, and opioids; immunizations against hepatitis B virus, varicella, and rubella; and screening for syphilis and HIV. Folic acid use before pregnancy is associated with reduced fetal neural tube defects (relative risk [RR], 0.67; 95% CI, 0.52-0.87). Maternal tobacco smoking is associated with increased risks of stillbirth (summary RR [sRR], 1.46; 95% CI, 1.38-1.54), neonatal death (sRR, 1.22; 95% CI, 1.14-1.30), and perinatal death (sRR, 1.33; 95% CI, 1.25-1.41). Screening for and treatment of syphilis and HIV prior to and during pregnancy decrease rates of fetal and neonatal infection. Prepregnancy immunizations against hepatitis B virus, varicella, and rubella decrease neonatal infection and mortality. Individuals using tobacco, alcohol, cannabis, and opioids should receive counseling and treatment prior to pregnancy (eg, buprenorphine or methadone for opioid use disorder). For individuals with chronic disease, routine health examinations and contraceptive care in the year before conception can optimize pregnancy timing and are associated with decreased risk of severe maternal morbidity. Compared with planned pregnancies, unintended pregnancies are associated with increased risk of postpartum depression (15.7% vs 9.6%; adjusted odds ratio [aOR], 1.51; 95% CI, 1.40-1.70), preterm birth (9.4% vs 7.7%; aOR, 1.21; 95% CI, 1.12-1.31), and low infant birth weight (7.3% vs 5.2%; aOR, 1.09; 95% CI, 1.02-1.21). Weight loss prior to conception is recommended for individuals with a body mass index of 25 or greater because overweight and obesity are associated with increased risk of gestational diabetes, gestational hypertension, and cesarean delivery. Among patients with pregestational diabetes (type 1 or 2), hemoglobin A1c of less than 6.5% is associated with a decreased risk of fetal anomaly compared with hemoglobin A1c of 6.5% or greater. Cardiovascular complications such as hypertension and heart failure occur in 15% of pregnancies and are more common among those with preexisting cardiovascular disease. These patients should receive counseling on maternal and neonatal risk, monitoring, and medication management by specialists in cardiology and maternal fetal medicine. Prepregnancy counseling and care reduce maternal morbidity and neonatal morbidity and mortality. Primary care-based discussion of reproductive goals, immunizations, screening for infections and substance use, and risk-reducing interventions such as folate supplementation can optimize outcomes in individuals contemplating pregnancy.
Appropriate reporting of race and ethnicity in rheumatology research is critical to ensure equity and diversity of study participants and findings, as sociodemographic factors can affect outcomes, particularly for systemic lupus erythematosus (SLE). JAMA published guidance on reporting of race and ethnicity, highlighting the importance of reporting appropriately and building on emerging guidance. This study aimed to quantify reporting of race and ethnicity in high-impact rheumatology journals to assess adherence to accepted reporting recommendations. Studies investigating issues related to SLE published in three of the highest impact rheumatology journals between 1/1/2020-12/31/2023 were included. Manuscripts not involving human subjects were excluded. Two researchers (I.E. and H.B.) systematically abstracted sociodemographic variables to ensure consistent coding of data; conflicts were resolved by consensus. Descriptive statistics of each variable and reporting criteria were calculated. In all, 117 articles met inclusion criteria. Among these, 114 (97%) included any demographic data, 87 (74%) reported race, 51 (44%) reported ethnicity. Of those that reported race, 65 (75%) were comprised of a majority White race and only 7 studies (8%) met the Office of Management and Budget (OMB) minimum reporting criteria for race. Only 20 studies (23%) mentioned that racial and ethnic categories were self-reported by patients. Additionally, 32 studies included any comorbidities, and 18 studies included various other socio-economic factors. Despite known racial and ethnic disparities in SLE care and outcomes, reporting of race and ethnicity is not standardized across SLE research in rheumatology journals. Most publications do not meet minimum suggested race and ethnicity reporting criteria.
This JAMA Patient Page describes the signs and symptoms of tetanus, the risk factors, vaccinations for prevention, and how it is diagnosed and treated.
Despite rising hepatitis C virus (HCV) incidence in pregnant people, studies demonstrate that fewer than 50% of perinatally exposed infants receive HCV testing. Few studies report treatment of infected infants or factors affecting testing. To identify birthing parent and child factors associated with appropriate HCV testing for perinatally exposed infants and characterize HCV care for children with HCV. This cohort study included records on testing, care, and treatment for Massachusetts children perinatally exposed to HCV between 2014 and 2021 from a statewide health database linking statewide vital statistics, infectious disease surveillance data, substance use treatment, and insurance claims data. Data were analyzed from April 2023 to June 2025. Linkage to a birthing parent with a confirmed (RNA positive) or probable (antibody positive; no RNA testing) HCV case reported to the Massachusetts Department of Public Health. Guideline-appropriate HCV antibody or RNA testing and HCV treatment were the main outcomes. Multivariable logistic regressions were used to analyze factors associated with guideline-concordant HCV testing. Between 2014 and 2021, 4548 children were born (between 0.7% and 1.3% of yearly births) in Massachusetts to 3693 birthing parents with probable or confirmed HCV; among 4103 children who were aged 2 years or older by study end (2103 male [51.3%]; 289 Black non-Hispanic [7.0%], 575 Hispanic [14.0%], 3069 White non-Hispanic [74.8%]; 3185 [77.6%] with public insurance at delivery), 41.9% completed appropriate perinatal HCV exposure testing. HCV was diagnosed in 40 (2.5%) of those tested; between 1 and 10 of 38 treatment-eligible children were treated by 2022 (number suppressed due to value between 1 and 10). Appropriate testing rates decreased over time and were lowest for those born in 2020 (32.3%; 95% CI, 28.9%-35.7%). A medical claim for the birthing parent's HCV within 30 days of delivery (adjusted odds ratio [aOR], 5.40; 95% CI, 4.19-6.96), medication for opioid use disorder treatment during pregnancy (aOR, 1.29; 95% CI, 1.09-1.51), and factors correlated with HCV risk were associated with significantly higher odds of appropriate testing; non-Hispanic Black race (aOR, 0.65; 95% CI, 0.45-0.94) and private insurance (aOR, 0.76; 95% CI, 0.62-0.93) were associated with lower appropriate testing odds. In this cohort study of perinatally exposed infants, HCV testing decreased over time, and few were treated. Communication and recognition of the birthing parent's HCV risk or diagnosis were associated with greater odds of testing completion; these modifiable factors could be addressed to improve equitable HCV testing and care.
Posttraumatic stress symptoms (PTSS) affect nearly 50% of children experiencing physical trauma. PTSS often persists after physical recovery and is associated with reduced health-related quality of life. To evaluate efficacy of the online therapist-assisted, trauma-focused Reducing Stress After Trauma (ReSeT) program in reducing PTSS in children after hospitalization for physical injury. A 2-arm randomized clinical trial with 1:1 assignment to the ReSeT program or usual care (UC) was conducted between 2021 and 2024 at 4 sites with level 1 trauma centers. Injured children ages 8 to 17 years were recruited from inpatient and short-stay units. Exclusion criteria included moderate to severe traumatic brain injury, preexisting severe psychiatric problems, current psychotherapy, developmental disorders preventing participation, interpersonal violence, hospitalization for more than 30 days, and injury-related death of friend or family. The ReSeT program has 8 online psychoeducational modules containing 3 to 4 short interactive videos that children completed independently. Modules are followed by an electronic health session with a therapist to practice cognitive behavioral skills and desensitization using trauma narrative techniques. Parents received optional psychoeducational resources. Generalized linear regression, controlling for baseline scores, was used to examine group differences on the Child Posttraumatic Stress Disorder Scale (CPSS) scores obtained 10 weeks (primary outcome) and 6 months (secondary outcome) after randomization. A total of 638 of 722 children screened positive at 1 week, and 271 children and caregivers completed the CPSS at 4 weeks. The highest value from each respondent on each item was summed, and 130 children (48%) had CPSS scores of 11 or greater, indicating potential eligibility for enrollment. A total of 93 children (72%; mean [SD] age, 11.7 [2.4] years; 56 male [60.2%]) were included in the study; 47 were randomized to the ReSeT cohort and 46 were randomized to the UC cohort. Intention-to-treat analyses indicated significant reduction in combined CPSS scores in the ReSeT vs UC cohorts, -4.2 points (95% CI, -7.6 to -0.8 points) at 10 weeks, which was maintained at the 6-month follow-up, -5.5 points (95% CI, -8.9 to -2.1 points). Findings of this randomized clinical trial show that the ReSeT program was an effective, brief, trauma-focused intervention for reducing PTSS after physical injury. It offers a potentially cost-effective, scalable program to address American College of Surgeons standards for psychological screening and treatment for children sustaining PTSS. ClinicalTrials.gov Identifier: NCT04838977.
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This cross-sectional study examines the clinical setting in which medications that affect cognition in older adults are initiated and the persistence of taking such medications in the same class 1 year later.
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Patients with giant cell arteritis (GCA) face an increased risk of major adverse cardiovascular events (MACE). The benefit of low-dose aspirin in these patients is unknown. To evaluate the 1-year association of low-dose aspirin with risk of MACE in primary prevention in patients with incident GCA and to evaluate the risk of major hemorrhage and net clinical benefit at predefined time points. This population-based cohort study used a target trial emulation framework with a cloning, censoring, and weighting approach within the French National Health Data System. Participants were individuals aged at least 50 years with incident GCA between 2010 and 2022, without previous cardiovascular events or antiplatelet or anticoagulant use at GCA diagnosis. Analysis was conducted from November 2024 to June 2025. Initiation of low-dose aspirin vs not (control group) within 14 days of GCA diagnosis. The main outcome was MACE, a composite end point of ischemic stroke, myocardial infarction, and all-cause mortality. Major hemorrhages were evaluated as secondary outcomes. A total of 14 528 individuals (median [IQR] age, 74 [67 to 80] years; 10 396 [72%] female), were included. Low-dose aspirin was initiated in 5220 individuals (36%). At 1 year, MACE risk was lower in the low-dose aspirin group (relative risk [RR], 0.86 [95% CI, 0.75 to 0.96]; risk difference [RD], -0.54% [95% CI, -0.99% to -0.12%]), while major hemorrhage risk was higher (RR, 1.29 [95% CI, 1.05 to 1.53]; RD, 0.51% [95% CI, 0.13% to 0.91%]). All-cause mortality was lower in the low-dose aspirin group at 1 year (RD, -0.43% [95% CI, -0.77% to -0.10%]). At 3 years, MACE events were less frequent in the low-dose aspirin group (RD, -1.08% [95% CI, -1.77% to -0.41%]), with no difference in major hemorrhages. A more pronounced association between low-dose aspirin and lower 1-year MACE was observed in women (RD, -0.78% [95% CI, -1.29% to -0.25%]) and patients with diabetes at GCA diagnosis (RD, -2.23% [95% CI, -3.48% to -1.02%]). In this retrospective cohort study, low-dose aspirin at GCA diagnosis was associated with lower MACE at 1 and 3 years but higher hemorrhage risk at 1 year. Subgroup analyses suggested heterogeneity according to sex and diabetic status.
Antibiotic overuse is harmful to patients and the health care system. Antibiotic prescribing report feedback has been described in outpatient and long-term care settings but is relatively untested in inpatient settings. To assess the association between peer comparative inpatient antibiotic prescribing feedback and changes to antibiotic prescribing rates among hospitalists in a large health care network. This quality improvement study linked data on billing and prescribing of broad-spectrum antibiotics for hospital-onset infections (BS-HO antibiotics) from hospitalists at 5 diverse acute care facilities encompassing both academic and primarily community-based hospitals within the same large health care network. Data were pooled into 12 two-month periods from January 1, 2023, through December 31, 2024, in a quality improvement intervention with a stepped-wedge cluster design. Hospitalists who contributed billed patient days for at least one 2-month period during the study period received the intervention. Observed-to-expected ratios (OERs) for days of therapy (DOT) of prescribed antibiotics were calculated for each hospitalist per period and reported back to hospitalists in a peer comparative report disseminated via email every 2 months. Hospitalists' prescribing rates for BS-HO antibiotics with activity against Pseudomonas aeruginosa were assessed, accounting for time, clustering of hospitalists, and patient characteristics including comorbidities and clinical syndrome. The study included 169 hospitalists (median per hospital, 30 [range, 24-50]) for a total of 1687 bimonthly observation periods. Per 2-month period, hospitalists had a mean (SD) of 126 (48) patient encounters. Among hospitalists at facilities receiving the intervention, the prescribing rate ratio (RR) for DOT was higher among clinicians caring for higher proportions of patients with sepsis (RR, 1.04; 95% CI, 1.00-1.08) and end-stage kidney disease (RR, 1.09; 95% CI, 1.05-1.14) and was lower for each sequential reporting period (RR, 0.99; 95% CI, 0.98-1.00). In multivariable models accounting for these variables and the trend over sequential periods, the intervention was not significantly associated with lower prescribing rates (RR, 0.97; 95% CI, 0.91-1.04). Peer comparative inpatient prescribing reports for hospitalists were not associated with a change in hospitalists' prescribing rates of BS-HO antibiotics. The findings suggest additional efforts to augment the utility of the reports are justified.
Colorectal cancer (CRC) is the second most common cause of cancer mortality in the US and disproportionately impacts individuals in underresourced settings. To compare 2 mailed population outreach approaches to increase CRC screening uptake among screening-eligible adults in community health centers (CHCs). This pragmatic cluster randomized clinical trial was conducted in 8 CHCs and an additional site in a nonrandomized parallel protocol. The CHCs were located in the greater Boston area in Massachusetts and Los Angeles County in California (randomized sites), and Rapid City, South Dakota (parallel site). Patients were enrolled in the trial between June 7, 2023, and October 24, 2023. English- or Spanish-speaking primary care patients aged 45 to 75 years, who were due for CRC screening, were eligible to participate. Patients received either mailed fecal immunochemical test (FIT) with automated text message outreach from study personnel or mailed FIT-DNA with the manufacturer's outreach protocol. Participants in Boston and Los Angeles (randomized sites) with an abnormal FIT or FIT-DNA result were offered standardized navigation to colonoscopy. The primary outcome was CRC screening participation using any modality (FIT, FIT-DNA, or colonoscopy) within 90 days. Secondary outcomes were screening within 180 days and time to screening participation. The completion of follow-up colonoscopy within 180 days of an abnormal stool test result was also studied. Among 5127 participants in the RCT regions, 2435 (47.5%) were in the FIT group, and 2692 (52.5%) were in the FIT-DNA group. The mean (SD) age was 54.5 (8.1) years; 3018 (58.9%) were female, and 2109 (41.1%) were male. There were 3818 Hispanic individuals (74.5%), 369 non-Hispanic Black individuals (7.2%), 763 non-Hispanic White individuals (14.9%), and 58 individuals of another race (1.1%). A total of 3363 individuals (65.6%) preferred the Spanish language; 2540 (49.5%) were Medicaid insured, and 614 were (12.0%) uninsured. Screening participation was significantly higher in the FIT-DNA group vs the FIT group at 90 days (751 of 2692 [27.9%] vs 550 of 2435 [22.6%], respectively; P = .02) and 180 days (854 of 2692 [31.7%] vs 649 of 2435 [26.7%], respectively). In Boston, screening participation at 90 days was higher (628 of 2208 [28.4%]) than in Los Angeles (673 of 2919 [23.1%]). Findings were similar at 180 days. Among the 100 individuals with an abnormal stool test result, 36 (36.0%) completed a colonoscopy within 180 days. In this cluster randomized clinical trial, CRC screening uptake was higher in the FIT-DNA group than in the FIT group and was higher in Boston compared to Los Angeles CHCs. The follow-up colonoscopy rate within 6 months was suboptimal, even with the availability of navigation. ClinicalTrials.gov Identifier: NCT05714644.
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