S0332 Improved Follow-Up of Fecal Immunochemical Tests for Colorectal Cancer Screening via Iterative Systems-Based Strategies

INTRODUCTION: Fecal immunochemical testing (FIT) is used for colorectal cancer (CRC) screening. Annual FIT—a first tier test along with colonoscopy—has the potential to achieve wider compliance with screening, including in vulnerable populations. The impact of FIT is dependent on the ability to follow up positive tests with colonoscopy. Failure to do so is associated with poor CRC outcomes. Patient, provider, and systems factors all negatively influence compliance with appropriate follow up. We sought to implement strategies to enhance our outcomes and the value of patient care. METHODS: The study was performed at the Department of Defenses' largest treatment facility in addition to several surrounding clinics. All FIT orders between January 2013 and December 2017 were previously analyzed and showed poor follow-up of positive tests. Subsequently, we adjusted our ordering system to require indication labelling so that patients with positive screening tests were identified in a highly reliable fashion and routed to a nurse navigator to link primary and subspeciality care, minimizing low value clinic visits. We tracked Time to colonoscopy and rates of colonoscopy completion. RESULTS: The rate of inadequate follow up for adult patients prior to our intervention was 34.8% (69/198). After our intervention, there was a significant reduction in the time to colonoscopy amongst patients with positive FIT who attained a confirmatory exam (average 129.9 ± 90.4 vs 19.7 ± 10.3 days, P < 0.0001). 89% of positive FIT patients have been scheduled for colonoscopy; of those that have completed a colonoscopy, 29% demonstrated high risk lesions. Of patients with positive screens, 73% were deemed to be able proceed directly to colonoscopy without preprocedural visit. Further data continue to be collected. CONCLUSION: Studies across multiple hospital systems show patients undergoing FIT for CRC screening are at risk for insufficient follow up and this failure is associated with worse CRC related outcomes. We improved process reliability by removing low value steps and optimizing communication of FIT results between the primary care and GI clinics. Interventions to improve follow-up include automated GI notification and collaborative consultation that streamlines clinically appropriate direct-to-colonoscopy scheduling. These findings provide support for the use of an electronic system to address positive FIT. Systems should consider allocating resources to support patients with positive tests in health care system navigation.