Implementing an Organized Colorectal Cancer Screening Program Across a Large Health System

Introduction: The effectiveness of mailed fecal immunochemical test (FIT) outreach for colorectal cancer (CRC) screening might be enhanced through an organized screening program, yet published real-world experiences are limited. We aimed to synthesize the implementation of an organized screening program which uses mailed FIT outreach in a large integrated academic-community practice including a safety-net healthcare system. Methods: Between 2017-2019, our stand-alone pilot mailed FIT program increased CRC screening by 16% (55% to 71%), but uptake differed by patient demographics. This data was shared with senior leaders and clinical and research champions and was the impetus for an institution-funded organized CRC screening program. In partnership with a centralized Population Health team and Primary Care, our program defined the: 1) institutional approach to CRC screening, 2) the target population and method for screening, 3) team responsible for implementation, 4) healthcare team responsible for decisions and care, 5) a quality assurance structure, and 6) a method for identifying cancer occurrence. The CRC screening program was implemented through an iterative process with input from key stakeholders. Results: The Fred Hutchinson/UW Medicine Population Health CRC Screening Program began in September 2021. After strategic hires, we identified 9,715 eligible patients for outreach between March and June 2022 (Figure 1). The workflow included a mailed postcard, a MyChart message from the primary care provider (PCP), a FIT kit with a letter from the program and PCP, and up to 3 bi-weekly reminders. Patients who did not complete a follow-up colonoscopy within 3 months of their abnormal FIT result, received navigation to colonoscopy through the CRC screening program. We contracted an in-house vendor for printing and mailing of materials and FIT kits were processed centrally. Between 2021 and 2022, the program increased screening from 68% to 70%, with similar increases observed by race, ethnicity, and socioeconomic status. Conclusion: Real-world experiences detailing how to implement organized CRC screening programs might increase adoption of this evidence-based intervention. In our experience, broadly disseminating pilot data, early institutional support and funding, strategic staff hires, strong cross-departmental relationships, and robust data management were critical to successfully implementing a screening program that benefits the entire healthcare system.Figure 1.: Outcomes of Mailed FIT Outreach.