S3257 Addressing Disparities in Colorectal Cancer Screening

Abstract

Introduction: Colorectal cancer (CRC) screening rates are significantly lower in low-income, minority populations nationally. Health system data from a large academic medical center revealed a 3% lower CRC screening rate amongst black patients and a 14% lower rate of CRC screening in the resident patient panels, which contain a greater percentage of high-risk, low-income patients. This novel resident-led quality improvement (QI) work identified causes for disparities in CRC screening, then implemented a resident-driven population health based protocol. Methods: Analysis was conducted across two academic primary care clinics at a single institution. Residents conducted chart reviews and targeted interviews of key stakeholders in the CRC screening process, including patients, physicians, and staff. An EMR-based dashboard was used to collect demographic data and CRC screening rates for colonoscopy and FIT tests for the patient panels for the year 2020. A population health protocol was then developed and implemented by residents during dedicated outpatient blocks. Results: Twenty-two structured interviews revealed scheduling algorithms, limited time during clinical encounters and patient and provider knowledge deficits as the top contributors to low CRC screening rates. Data generated from a central database revealed colonoscopy compliance rates to be 76% for attending panels versus 62% for resident panels, and compliance for FIT to be on average 15% higher than colonoscopies. An established navigator program for improving CRC screening was only effective in 30% of patients. Based on these results, a population health protocol was developed for residents to outreach patients with lapsed CRC screening outside the office visit and streamline referrals to the navigator program for high-risk patients. Thus far, 18 residents have implemented the protocol and 266 patients have been outreached. Conclusion: Multiple factors lead to disparities in CRC screening including intricacies within the health system but also experience in practice. Interventions are being studied to counteract such factors and improve disparities that disproportionately impact minority patients. This QI initiative demonstrates that a resident-led intervention outside the clinical visit can reach a significant number of high-risk patients. In the next phase of data collection, we will examine the impact of our protocol on the number of additional colonoscopies and FIT tests completed.