S250 Increasing Fecal Immunochemical Test Return Rates by Patient Reminders: A Quality Improvement Study

Abstract

Introduction: The incidence of colorectal cancer (CRC) in the United States is increasing, and it remains the second leading cause of cancer death in the United States for men and women combined. The American Cancer Society now recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high sensitivity stool-based test or structural (visual) examination, depending on patient preference and test availability. The primary objective of this quality improvement project was to determine if reminder methods, such as telephone or letter reminders, increased the return rate of fecal immunochemical tests (FIT) for colorectal cancer screening. Methods: At public outreach events and daily clinics in the West Texas Panhandle area, participants in the GET FIT program were provided with FIT kits after completing the education on colorectal cancer. Participants who fit the inclusion criteria and had received a FIT kit from the program were included. They were instructed on how to perform the test and mail it back. Participants that did not return the completed kits within two weeks were reminded either by 1) through a reminder letter or 2) by telephone every 2 weeks (+/- 3 days) for 60 days or 5 attempts to contact. We de-identified and analyzed the FIT kit return data from June-November 2019 before instituting these reminder methods. We then calculated the change in return rates from December 2019 to February 2020. Our goal was to increase the FIT return rates by 25% over the baseline return rate. Results: The pre-intervention return rate of kits for June-November 2019 was 67.58%, and the postintervention return rate for December 2019-February 2020 was 81.87%. This rate was equal to an approximately 21% increase in return rates. The average return rate of FIT kits overall was 72.34%. The average rate of returned new patient kits was 69%, and the average % of new patient return kits was 68.51%. We also noticed a significant increase in return of FIT tests after a community cancer screening in October 2019. Conclusion: Fecal immunohistochemical test (FIT) remains one of the primary options for colorectal cancer screening. Due to its lower cost and noninvasiveness, FIT was offered to patients at average risk.We did achieve a significant increase in return rates, although we did not meet our target goal for this project. Our project was limited to studying 3 months post-intervention due to the COVID pandemic and barrier in returning tests. (Table Presented).