Improving Colorectal Cancer Rates in Primary Care: 1103

Introduction: Nationally, 67% of eligible patients are up to date with colorectal cancer (CRC) screening. Grady Health System is a large, urban hospital located in Atlanta, GA. The Primary Care Center (PCC) at Grady consists of resident-staffed “pods” and has approximately 70,000 patient visits per year. The patient population is largely African American and uninsured. At Grady, CRC screening options for the average risk patient include a colonoscopy every ten years or an annual fecal immunochemical test (FIT). In 2017, in the PCC, only 55% of eligible patients were screened for CRC. Colonoscopies make up the majority of PCC screening, but have many barriers, including long wait times and the need for transportation or multiple visits. Thus, we decided to emphasize the FIT option in hopes to keep our patients up to date on screening and risk stratify patients to prioritize who receives colonoscopies. This project aims to increase the rate of CRC screening by 20% in average risk primary care patients aged 50-75 by July 2018. Methods: Initially, we examined the percentage of eligible patients in the PCC who received appropriate CRC screening. We created a multi-tiered educational approach focused on importance of CRC screening and FIT availability, which included resident-led education sessions targeting PCC clinicians and staff as well as patient waiting room education. We are also optimizing the medical record to streamline referrals and automatically update the health maintenance section. Results: Approximately 70 resident-physicians and 20 members of nursing staff attended the educational sessions. These sessions improved provider comfort with FIT use, and 94% of the residents agreed that they are now more likely to discuss FIT and colonoscopy testing with their patients. Additionally, 88% feel they are more likely to refer patients for screening. CRC screening rates have remained relatively constant throughout our intervention. FIT orders among our eligible population has increased from 2.9% to 8.6%, and completed CRC screening with FIT has doubled from 0.6% to 1.2% in the last four months. Conclusion: As our educational sessions took place in March, we have not yet seen a change in screening rates. However, ordering rates for FIT have nearly tripled and completed screening with FIT has doubled. This dichotomy is likely explained by the delay between ordering FIT or colonoscopies and patient completion. We anticipate an increase in overall screening rates in the near future.