S936 Factors Associated With Fecal Calprotectin Sample Collection Compliance: An IBD Center Quality Improvement Project

Abstract

Introduction: Regular assessment of objective markers of inflammatory bowel disease (IBD) activity is recommended. Fecal calprotectin (Fcal) is a non-invasive and inexpensive biomarker of disease activity, however, patient compliance with this test is variable and incompletely described. We assessed compliance rates with Fcal tests and identified factors associated with non-compliance. Methods: As a quality improvement project, we conducted a retrospective chart review of IBD patients who had a Fcal test ordered by us between August 2021 and December 2021. Demographic, clinical, disease-related, and test-related (location of lab relative to the patient’s visit in clinic or at home) information were recorded to determine predictors for non-compliance. Simple statistical analysis and multivariable logistic regression was performed. Results: Of 303 patients, 165 (54.4%) had an order for Fcal. Of the Fcal tests ordered, 55 (33.3%) were not completed. Between those with complete versus incomplete tests, IBD remission status (67.8% vs. 83.7%, p = 0.033), history of prior Fcal order completion (93.2% vs. 68.4%, p = 0.001), and test ordered to an external site (62.7% vs. 85.5%, p = 0.004) were significantly different. A multivariable logistic regression with these factors as well as age, gender, telehealth vs. in-person consultation, and patient residence revealed that history of a prior completed Fcal test is independently associated with subsequent test completion (odds ratio (OR) = 8.3, 95% CI 1.9-35.5, p = 0.004). Fcal testing location (institutional or third-party) was marginally significant (OR = 0.27, 95% CI 0.7-1.0, p = 0.051). A multivariable linear regression for days between test order and completion found that tests ordered for external locations are associated with delayed completion (95% CI 5.2-20.6, p = 0.002). Conclusion: In this single center analysis with Fcal testing in patients with IBD, we found that a history of incomplete testing is associated with subsequent non-compliance, and distant location of the lab is associated with delayed completion of the test. These findings suggest that ordering providers should identify additional methods to educate on the importance of disease monitoring with Fcal and when possible, simplify the lab used for testing. Future availability of at home Fcal tests may be helpful in this regard. Table 1. - Linear Regressions for Predictors of Fecal Calprotectin Compliance Logistic Regression for Test Compliance Regression for Delayed Testing Completion Estimate Effect Size (B) Standard Error P - Value 95% Confidence Interval Estimate Effect Size (B) Standard Error P - Value 95% Confidence Interval Age 0.017 0.015 0.248 0.998-1.048 0.148 0.104 0.163 -31.309-7.575 Gender -0.441 0.543 0.417 0.222-1.866 0.877 3.635 0.810 0.062-0.357 IBD Remission -0.949 0.624 0.128 0.114-1.316 -0.331 3.895 0.933 -6.421-8.176 Consultation Type -.0523 0.528 0.322 0.210-1.570 0.102 3.992 0.980 -8.151-7.490 History of Fecal Calprotectin Completion 2.116 0.741 0.004 1.942-35.493 6.628 2.625 0.357 -7.699-20.956 Fecal Calprotectin Testing Location -1.304 0.668 0.51 0.073-1.005 12.875 3.843 0.002 5.160-20.591