2847 Outside the Scope a Better FIT for Some Patients

Abstract

INTRODUCTION: Colorectal cancer is the 3rd most common cancer in American adults and is the 2nd most common cause of cancer death. Colorectal cancer screening (CRCS) is unique because it not only detects but also prevents cancer from ever developing, something no other cancer screening accomplishes. Despite this advantage, in 2015 the national average for CRCS compliance was only 63%, below the National Colorectal Cancer Roundtable (NCCR) goal of 80%. The reason for the low rate of CRCS is multifactorial including the fear of having a colonoscopy. At the Baylor Scott & White Primary Care Clinic in Round Rock, TX, CRCS compliance in 2019 was 54% for commercial insurance and 73% for Medicare patients. Our goal was to increase our CRCS compliance and provide better preventative care for our patients. METHODS: We reviewed the charts of 200 randomly selected patients who were considered non-compliant with CRCS between September 2017 to September 2018. Non-compliance was defined as a patient who was eligible for CRCS in this one-year time frame but failed to have CRCS. This helped identify causes for why CRCS was not performed. In our review, 0% of these patients were offered alternative methods of CRCS besides colonoscopy. This information led us to educate attending and resident physicians with oral presentations on the availability of alternative testing modalities for CRCS. In addition, one of these modalities, fecal immunochemical test (FIT) kits, were placed in patient rooms in our primary care clinic. Providers were asked to offer patients a colonoscopy for CRCS, and if a patient refused, to then offer FIT testing. RESULTS: Among noncompliant patients, no modalities aside from colonoscopy were mentioned by providers for CRCS to non-compliant patients. With the implementation of FIT kits, patients were more inclined to undergo CRCS. From January to March 2019, there was a 12% CRCS compliance rate. After our intervention in April 2019, CRCS compliance was 18% in April 2019, with the entire 6% increase in compliance coming from FIT test kits. CONCLUSION: Despite its benefit, CRCS remains below compliance goals set by NCCR. By having FIT kits placed in all the clinic rooms, it was more convenient for patients to have CRCS. There will be continued education on the benefits and modalities of CRCS to more health care providers. We plan to implement this project at other Baylor Scott & White Primary Care Clinics in the region.