Time to colonoscopy and insurance status at an FQHC.

Abstract

e18543 Background: In 2021, Federally Qualified Health Centers (FQHCs) cared for over 30 million patients, 68.7% of whom had Medicaid or were uninsured. FQHCs face challenges to obtain colonoscopies for patients, as many specialists are outside of network coverage or do not accept uninsured patients. As such, many FQHCs use fecal immunochemical testing (FIT) as an initial colon cancer screen. A positive FIT requires a follow-up colonoscopy. Follow-up colonoscopy rates range from 18% to 57% at FQHCs nationally. This study investigates a possible relationship between insurance status and time to colonoscopy after a positive FIT at an FQHC in Chicago. Methods: We performed a retrospective chart analysis. Charts were obtained from the electronic health record by an informatics team. Patients aged 45 years or older with a positive diagnostic FIT between 12/2020 and 12/2021 were selected. We evaluated insurance status, date of positive FIT, date of colonoscopy when applicable, and colonoscopy results. Results: A total of 314 patients were identified of which, 169 (53.8%) were insured and 145 (46.2%) were uninsured. From the 44 (13.7%) patients that completed colonoscopies, 25 (58.1%) were insured and 18 (41.9%) were uninsured. A Chi-square test revealed no significant relationship between patients who did or did not have a colonoscopy and insurance status. The mean number of days between positive FIT and colonoscopy was 124.7 (SD 64.7) and ranged from 38 to 309 days. A two-sample t-test found no significant difference in the mean time to colonoscopy between insured and uninsured patients. Colonoscopy results revealed the majority of patients (N = 23, 53.5%) had benign tumors with only one patient having cancer. Conclusions: In this study, insurance status did not impact time to obtain a colonoscopy. Only 13.7% of patients had a colonoscopy, lower than national rates. Several factors likely contributed to low follow-up rates, including the COVID-19 pandemic, insurance type, language barriers, and colonoscopy scheduling wait times. Establishing strong hospital partners, use of reminder calls, education and encouragement from providers, and emphasizing follow-up could improve colonoscopy rates. [Table: see text]