CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH NO PRIOR FECAL IMMUNOCHEMICAL TESTING (FIT) IN A MAILED FIT OUTREACH PROGRAM

Introduction: Colon cancer (CRC) is the 2nd leading cause of cancer-related death in Georgia with 1,400 deaths yearly.CRC incidence and mortality decreases by 61% when patients are screened appropriately using society recommendations.While the national screening rate is 71% and GA statewide rate is 68%, at GA federally qualified healthcare centers (FQHCs) the screening rate was 32% in 2017.The aim of this study was to determine if a physician led, low cost intervention, can result in a sustained increase in CRC screening rates at FQHCs in Georgia.Methods: Between April-July 2018, two physicians conducted a CRC quality improvement intervention at four GA FQHCs to improve CRC screening rates at these sites.The team provided educational lectures about colon cancer to providers, reviewed screening processes to identify gaps and used guideline recommendations to help clinics develop a policy to ensure eligible patients get screened.They also provided patient education materials such as brochures, posters, and postcards.As a federal grant requirement, FQHCs must report colon cancer screening rates using the federal Electronic Clinical Quality Improvement system.We assessed CRC screening rates at 3 months & 1 year post intervention.This was done utilizing a population based sample at the sites, including all screening eligible patients, defined as patients 50-74 at average risk for colon cancer.Categorical data were presented as percentages and total numbers then analyzed using Chi-square testing.Results: All centers has a significant increase in CRC screening rates at 3 months following intervention (table).At the 12-month interval, three centers had further improvement in CRC screening rates compared to baseline, showing durability of the intervention (table ).However, at site 4, the initial increase in CRC screening rate observed at the 3-month post intervention interval was not sustained at the 12-month assessment period (table ).Instead, a decrease in CRC screening rate was noted at the 12 month period compared to the preintervention rate (table).Discussion: Our physician driven program created a long term increase in CRC screening rates at three out of four FQHCs for the underserved in Georgia.The multifaceted approach included direct provider education sessions with an emphasis on FIT testing, systems process improvements and providing patient education resources.These low cost strategies increased screening rates at 3 of 4 sites tested at both 3 and 12 months post intervention.At one FQHC, screening initially increased, but was not sustained at the 12-month interval, suggesting a need for repeat intervention.Based on the overall results of this investigation, this program, if implemented at all FQHCs nationwide, has substantial durability as well as the potential to improve CRC mortality for the nation's most vulnerable patients.Table.Pre and post intervention screening rates by federally qualified heath center