S319 Improving Colorectal Cancer Screening to Implement New Guidelines

Abstract

Introduction: Colorectal cancer (CRC) is the 2nd leading cause of cancer-related deaths in the U.S. The American College of Gastroenterology recently updated their CRC screening guidelines in March 2021 to screen ages 45-75. The U.S. Preventive Services Task Force also added Grade B recommendations to screen individuals aged 45-49 as of May 2021. With these updates in mind, a quality improvement project was initiated to increase CRC screening in patients aged 45-49 years. Methods: Our primary objective was to improve rates of CRC screening in ages 45-49. Only average risk patients aged 45-49 with no prior CRC screening were included. Patients with a personal or family history of CRC, adenomatous polyps, Lynch syndrome, familial adenomatous polyposis, & recent gastrointestinal bleed were excluded. In June 2021, our institution’s healthcare gaps were modified to include CRC screening for ages 45-49. Patients 3 months pre-intervention were compared to those 3 months post-intervention. Baseline demographics were also assessed. The type of screening, adenoma detection rates, colonic lesion rates, & malignant neoplasm rates were evaluated as secondary outcomes. (Figure) Results: Overall demographics were similar between the two groups. Both had similar age, BMI, sex, race, & ethnicity. The amount of open healthcare gaps, use of alcohol, & tobacco use were also very similar. We found a statistically significant improvement in CRC screening rates after the intervention. A total of 59 patients (0.0445%) completed CRC screening pre-intervention. While 131 patients (0.0989%) received CRC screening post-intervention. Our primary objective was met with a P < 0.0001. A comprehensive increase of 71 patients received CRC screening post-intervention. Secondary outcomes however revealed no significant difference between the pre & post-intervention groups. (Table) Conclusion: Our implementation did not assess other CRC screening modalities other than colonoscopy & FIT MTS-DNA stool testing as our institution predominantly uses these two methods for screening. Despite this limitation, our project successfully achieved its goal. A total of 71 additional patients completed CRC screening. This translates to an improvement of CRC screening by over 200%. Though there was no significant difference in detecting malignant adenomatous neoplasms, this increase still theoretically translates to detection of 2 additional patients diagnosed with CRC per epidemiological studies. Overall further work needs to be done to improve our CRC screening rates.Figure 1.: Number of Patients Who Received Colorectal Cancer Screening by Month Table 1. - Demographics & Outcomes Pre-Intervention Post-Intervention P-value Median Age 48 47 Median BMI 30.5 29.6 Male Sex Percentage 54.2% 46.9% P = 0.53 [95% CI: -0.147 to 0.285] Median Care Gap Score¶ 3 3 Max Care Gap Score♠ 7 7 Average Alcohol Use Per Week 3 / week 4 / week Smoking Percentage♥ 8% 20% P = 0.073 [95% CI: -0.238 to 0.010] Caucasian Race 86.4% 91.3% P = 0.736 [95% CI: -0.343 to 0.240] African American Race 4.7% 4.31% Hispanic Ethnicity 0.53% 0.63% Asian Americans and Pacific Islanders Race 0.79% 0.80% Total Patients Eligible for CRC♣ Screening 132452 132432 Total CRC Screened Number of Patients 59 131 Total CRC Screened Percentage 0.0445% 0.0989% P < 0.0001 [95% CI: -0.000748 to -0.000340] CRC Screened through Colonoscopy 59 80 CRC Screened through FIT MTS-DNA 0 51 Adenoma Detection Rate on Colonoscopyº 44.1% 38.8% P = 0.63 [95% CI: -0.162 to 0.269] Colonic Lesion Detection Rate on Colonoscopya 42.4% 40% P = 0.83 [95% CI: -0.192 to 0.240] Malignant Adenomatous Neoplasms Detection Rate on Colonoscopy 0% 0% ¶Median number of healthcare gaps that were unresolved in patients after CRC screening took place♠. Maximum number of healthcare gaps that were unresolved in patients after CRC screening took place♥. Percentage of patients with any prior history of smoking as documented by Social History.♣. Colorectal Cancer.ºPercentage of patients who were found to have 1 or more precancerous polyps detected on colonoscopy.a. Percentage of patient who were found to have colonic lesions of any kind aside for polyps on colonoscopy.