Ambulatory Safety Net Improves Colorectal Cancer Recall Following a Positive Non-invasive Colon Cancer Screening Test

Introduction: With the increasing use of non-invasive colorectal cancer (CRC) screening tests, it is of increasing importance to institute a recall system to identify patients with positive results who are due for urgent colonoscopy. Our study is the summary of the implementation of an ambulatory safety net (ASN) in a large healthcare system to identify patients with positive non-invasive tests that did not undergo colonoscopy within 3 months of the result. Methods: Funded from a CRICO grant, Beth Israel Lahey Health developed a system wide ASN. To start the ASN, records from August 2021- February 2023 at 2 hospital sites were reviewed to identify patients who underwent a non-invasive CRC test and did not have a colonoscopy within 3 months of the positive results. A patient navigator attempted to outreach to patients via phone, patient portal, text messaging and/or letters mailed to patients. A Patient Navigator’s objective was to facilitate the scheduling of a diagnostic colonoscopy. Results: One hundred and ninety-eight patients were identified as potentially having a delay in colonoscopy scheduling following positive non-invasive CRC test. Of the 198, 54% of patients were not followed up by the navigator for the following reasons: had a procedure scheduled (n=32), completed colonoscopy (n=33), no longer clinically indicated (n=38) and 4 were excluded from the ASN for other reasons. The remaining 91 (46%) patients were contacted via multiple modalities with phone and portal messages being the most common. Of the 91 patients, the navigator facilitated scheduling overdue colonoscopies for 19 patients (21%). Successful outreach was achieved on the first phone call, portal message or text message in all but 1 case that required a second call. On average, it took the navigator 13.5 mins to review a chart for eligibility in the ASN. First phone calls took an average of 6 mins while text messages took an average of 15 mins/patient associated with the back-and-forth messaging to patients. In 4 patients monitored in a time-study, scheduling a colonoscopy took an avg of 47.5 min/patient to schedule their procedure. See Table 1 for details. Conclusion: The current local recall systems in place failed to identify all patients in need of urgent colonoscopy following a positive non-invasive CRC test. Setting up a system-level ASN is critical to the safety of a non-invasive CRC screening program as it facilitates loop closure and potentially can mitigate delayed or missed diagnoses of CRC. Table 1. - ASN Patient Outreach Data as of 5/25/2023 Chart Reviews Completed 198 Total # of Patents Excluded = 107 Reasons for Exclusion: Already scheduled* 32 Not clinically indicated 38 Colonoscopy completed 33 Unable to confirm finding in chart 2 Declined through shared decision-making w/provider 1 Other 1 # ASN Patients Eligible for Outreach = 91 Outreach by Modality Total # of Outreach Attempts = 127** Total # Patients Successfully contacted = 35 Patient Portal 40 7 1st Phone call 48 20 Text 14 6 2nd Phone call 14 1 3rd phone call/attempt 4 0 Letter (sent if patient unreachable) 11 1 # of Patients Scheduled for Colonoscopy 19 # of Patients Declining Colonoscopy 12 Other Patient Outreach Data Waiting for order prior to outreach 15 Excluded during outreach 4 Patients waiting for clinical consult 4 Patients wanting to repeat FIT test 3 Patients agreed to Colonoscopy but not yet scheduled 4 Active patients engaged in the outreach process 34 *Patients already scheduled (found during chart review) are not ASN eligible but will be followed to completion.**Some individual patients might have received more than one outreach attempt.