Improving Colorectal Cancer Screening Rates Within a Safety-net Hospital Primary Care System: 1452

Introduction: Screening for colorectal cancer (CRC) can result in significant mortality reduction, yet nationwide screening rates remain low, particularly among minority groups and the underserved. While colonoscopy is cited as the most sensitive test for CRC screening, among ethnic minorities, there is significantly lower patient adherence to colonoscopy versus noninvasive modalities. Harborview Medical Center (HMC) is a safety-net hospital providing care to an ethnically diverse, predominantly low-income patient population, including indigents without third-party coverage and patients with limited English proficiency. Among HMC primary care clinics in 2012, only 12.3% of 5,566 eligible outpatients completed fecal immunochemical testing (FIT). We proposed a two-part intervention to increase screening with FIT: 1. streamlined “FIT kits” and 2. Development of patient educational materials about CRC screening. Methods: We used an interrupted time series design to assess CRC screening rates before and after a population-wide intervention. Study participants were patients eligible for CRC screening (aged 50-75 years without colonoscopy in 10 years, flexible sigmoidoscopy in 5 years, or FIT in the last year). Patient educational materials on CRC screening were distributed. Those patients opting for non-invasive testing received a FIT kit (1 sample tube, toilet hat for ease of collection, modified FIT instructions and return envelope with pre-paid postage). CRC screening rates were assessed at 6 months, with plan to reassess at 12 months. Results: At 6 months, there was a significant increase in overall screening with FIT (19.4% vs. 12.3%, p < 0.05). Screening rates increased significantly (all p < 0.05) in four of six clinics: Adult Medicine Clinic 4.9% to 17.7%; International Medicine Clinic 24.6% to 29.0%; Madison (HIV/AIDS) Clinic 4.1% to 9.0%; and Pioneer Square (homeless/mentally ill) Clinic 9.7% to 16.8%. Conclusion: This two-part intervention resulted in a statistically significant increase in CRC screening rates by FIT among this vulnerable patient population. While additional analyses are needed, including reassessment at 12 months to document durable response, these data suggest that simple populationwide interventions represent an effective approach to increase CRC screening.