326 Implementation of Patient Navigators Reveals Barriers to and Increases Uptake of Colonoscopy After Positive Fecal Immunochemical Tests

Abstract

INTRODUCTION: Patients with abnormal fecal immunochemical test (FIT) results require diagnostic colonoscopy to reduce mortality from colorectal cancer (CRC). Barriers to follow-up are multifactorial and include patient-, provider-, and system-level factors. Patient navigators (PN) can be effective in improving follow-up by helping patients overcome these barriers. We aimed to assess the impact of PN on clinical care processes required for colonoscopy completion after positive FIT in a large, academic health care system. METHODS: We included all UCLA Health outpatients with an abnormal FIT result between 12/1/2016 and 12/01/2018 without documentation of a colonoscopy. Two PN underwent training with a gastroenterologist and quality officer. For all FIT positive patients, PN 1) conducted a chart review to confirm lack of colonoscopy completion, 2) contacted the primary care provider when there was an inappropriate reason for lack of colonoscopy, and 3) called patients to review FIT results, encourage follow-up, address barriers, and schedule a colonoscopy. Intervention endpoints were 1) colonoscopy completion, 2) patient refusal, 3) provider felt colonoscopy inappropriate, and 4) patient left the health system. We determined the proportion of patients that reached each endpoint at 4 months and reasons providers reported that colonoscopy was not indicated after positive FIT. RESULTS: Our cohort included 131 subjects. Mean age was 62.8 (±7.3), 50.3% were female, and 49.6% were White. In all, 87 (66.4%) reached an intervention endpoint at 4 months (Figure 1). Twenty-seven (31.0%) received diagnostic follow-up: 12 (44.5%) had colonoscopy, 3 (11.1%) had CT colonography, 1 (3.7%) had sigmoidoscopy, and 11 (40.7%) reported colonoscopies outside the health system. Primary care providers that were contacted by the PN often did not feel colonoscopy was indicated (25, 19.1%), and many (10, 40.0%) cited recent colonoscopy (Table 1). There were 19 (21.8%) patients that refused follow-up colonoscopy. CONCLUSION: PN was effective in increasing diagnostic follow-up after positive FIT and revealed persistent challenges to appropriate resolution of positive FIT. Future efforts will improve provider education about appropriate use of FIT and evaluate if PN can improve timely diagnostic follow-up when tracking positive FIT patients prospectively.