Screening Rates Research Articles

Enhancing screening for nutritional causes of anemia in hospitalized patients with cancer.

367 Background: Anemia in patients with cancer has been associated with lower quality of life, diminished performance status, and potentially even delays in chemotherapy. Multiple professional societies, including the NCCN and ESMO, recommend routine testing for iron deficiency and iron replacement if deficiency is identified. The aim of this quality improvement project was to increase testing for nutritional causes of anemia, especially iron deficiency, among patients admitted to the onco-hospitalist teaching service at MD Anderson Cancer Center. Methods: A process map was constructed to identify pitfalls with the current process for identifying and ordering testing for nutritional (iron, B12, and folate deficiency) causes of anemia. The primary intervention for our Plan-Do-Study-Act (PDSA) Cycle was creating and implementing an electronic medical record smart phrase to be included in each note prompting consideration of reversible causes of anemia and whether testing was ordered in the last 6 months or needs to be ordered. Education was also provided to residents regarding reversible causes of anemia and appropriate studies to order. Fliers describing the intervention and the recommended testing algorithm were placed in the resident workroom. A retrospective chart review of all patients admitted to the onco-hospitalist teaching service from August 2023 to February 2024 was employed to collect pre- and post-intervention data, and a run chart was created to plot rates of screening over time. Results: Of the pre-intervention cohort (n=263) from August to December 2023, 196 (74.5%) were identified as having anemia; of these patients, 109 (55.6%) underwent screening for nutritional causes of anemia during the admission. After our intervention was implemented, of all patients admitted to the service (n=186), a total of 156 (81.7%) were found to have anemia and 116 (74.3%) were screened for reversible causes of anemia. Almost all reversible causes of anemia were found to be secondary to iron deficiency. Conclusions: Our data shows that anemia is prevalent in our patient population yet inconsistently evaluated at baseline. At the same time, a combination of smart phrase utilization and education successfully increased rates of screening from 55.6% to 74.3% of patients admitted to the onco-hospitalist teaching service. One potential future endeavor is addition of a smartphrase to the admitting H&P templates to prompt teams to consider reversible causes of anemia, especially iron deficiency, during the admission.

Improving routine mental health screening for depression and anxiety in a paediatric lupus clinic: a quality improvement initiative for enhanced mental healthcare

BackgroundMental health (MH) conditions are prevalent in adolescents with childhood-onset SLE (cSLE). Early identification is crucial in preventing poor patient outcomes; however, MH screening rates remain low.Local problemFrom July 2021–January...

USPSTF Colorectal Cancer Screening Recommendation and Uptake for Individuals Aged 45 to 49 Years

In May 2021, the US Preventive Services Task Force (USPSTF) issued a grade B recommendation encouraging colorectal cancer (CRC) screening among average-risk individuals aged 45 to 49 years. The patterns of screening uptake and possible socioeconomic disparities in screening in this age group remain unknown. To evaluate changes in CRC screening uptake among average-risk individuals aged 45 to 49 years after the USPSTF recommendation was issued in 2021. This retrospective cohort study used deidentified claims data from commercially insured Blue Cross Blue Shield beneficiaries aged 45 to 49 years across the US between January 1, 2017, and December 31, 2022. Publication of the May 2021 USPSTF CRC screening recommendation for adults aged 45 to 49 years. Absolute and relative changes in screening uptake were compared between a 20-month period preceding (May 1, 2018, to December 31, 2019) and a 20-month period following (May 1, 2021, to December, 31, 2022) the USPSTF recommendation. Interrupted time-series analysis and autoregressive integrated moving average models were used to evaluate changes in screening rates, adjusting for temporal autocorrelation and seasonality. In this cohort study of 10 221 114 distinct beneficiaries aged 45 to 49 years (mean [SD] age, 47.04 [1.41] years; 51.04% female), bimonthly mean (SD) numbers of average-risk beneficiaries were 3 213 935 (31 508) and 2 923 327 (105 716) in the prerecommendation and postrecommendation periods, respectively. Mean (SD) screening uptake increased from 0.50% (0.02%) to 1.51% (0.59%) between the 2 periods (P < .001), representing an absolute change of 1.01 percentage points (95% CI, 0.62-1.40 percentage points) but no significant relative change (202.51%; 95% CI, -30.59% to 436.87%). Compared with average-risk beneficiaries residing in areas with the lowest socioeconomic status (SES), those residing in areas with the highest SES experienced the largest absolute change in screening (1.25 [95% CI, 0.77-1.74] percentage points vs 0.75 [95% CI, 0.47-1.02] percentage points), but relative changes were not significant (214.01% [95% CI, -30.91% to 461.15%] vs 167.73% [95% CI, -16.30% to 352.62%]). After the recommendation was issued, the screening uptake rate also increased fastest among average-risk beneficiaries residing in the areas with highest SES (0.24 [95% CI, 0.23-0.25] percentage points every 2 months) and metropolitan areas (0.20 [95% CI, 0.19-0.21] percentage points every 2 months). This study found that among privately insured beneficiaries aged 45 to 49 years, CRC screening uptake increased after the USPSTF recommendation, with potential disparities based on SES and locality.

Improving distress screening in radiation oncology consultation.

332 Background: Receiving a cancer diagnosis and awaiting initial management recommendations is a stressful time. Distress should be recognized, documented, and treated promptly as part of quality oncologic care. The NCCN Distress Thermometer (DT) is a useful tool for patients to quantify their level of distress. This pilot study assesses the rate of distress screening at a high-volume academic healthcare network, before and after institutional quality improvement (QI) intervention. Methods: All patients seen for Radiation Medicine between 1/1/22 - 12/31/23 were reviewed. Rates of DT documentation at the time of consultation were assessed as the QI metric. Patients seen in 2022 served as a baseline of departmental compliance. The importance of distress assessment was formally introduced to physicians and advanced care practitioners (ACPs) in Q4 2022 during monthly departmental quality reports, with notice that a formal QI metric would be monitored beginning 1/1/23. Chi-square test was used to compare rates of DT documentation. Monthly departmental DT documentation rates were back presented to the physicians and ACPs during quality meetings. Results: 9391 patients were seen for radiation oncology consultation (2022 = 4311; 2023 = 5080). Baseline DT documentation was 51.0%. Initial compliance with the metric was below baseline, at 41.4% for Jan 2023. With continued feedback, education, and goal-setting, rates of DT use continually improved over Q1/Q2 2023 and remained relatively steady through the remainder of Q3/Q4 2023, reaching a monthly high of 89.8%. Overall DT documentation significantly improved for 2023 was 81.4% (χ 2 = 977.9, p &lt; 0.0001). The rates of DT documentation were relatively consistent based on diagnoses codes, though lower amongst consults seen for metastatic disease (84.0% vs 73.4%, χ 2 = 24.28, p &lt; 0.0001). Conclusions: Screening rates at consultation are modifiable and maintainable, but distress management remains a continuous quality improvement project as we explore services to address identified stressors and reassess distress levels at future visits.

Telehealth utilization and adherence to cervical cancer screening among women in the United States.

383 Background: Cervical cancer (CC) screening has dramatically reduced incidence and mortality from cervical cancer over the last 5 decades. However, the prevalence of overdue screenings is increasing in the United States (US). Telehealth helps facilitate access to health care and services, but its impact on CC screening adherence is unknown. Methods: Data for this cross-sectional study were obtained from the 2022 Health Information and National Trends Survey, including female respondents aged 21-65 years. Women with a history of CC and missing data were excluded. Telehealth utilization (yes/no) was defined as having received care from a doctor or health professional using telehealth (i.e., phone and/or video) in the past 12 months. The outcome was adherence to CC screening (yes/no), measured as having a Pap test within the last 3 years. Weighted percentages and 95% CIs were compared using Chi-squared tests. Multivariable logistic regression models were fit to assess the association between telehealth utilization and adherence to CC screening, overall and by race/ethnicity. All analyses accounted for survey weights. Results: The study sample included 2,029 unweighted respondents, representing a weighted sample of 81,500,000 US women eligible for CC screening. Overall, 46.2% had a telehealth visit in the past 12 months. The mean age was 44 years; 57% were Non-Hispanic White, 19% were Hispanic, 13% were Non-Hispanic Black, and 11% were Asian or Pacific Islander. Telehealth users were more likely to be college graduates (43% vs. 35%, p=.047), insured (93% vs. 87%, p&lt;.001), and to have had at least one comorbidity condition (69% vs. 48%, p&lt;.001). After controlling for covariates, telehealth users had higher odds of adherence to CC screening than non-users (adjusted odds ratio [aOR] 1.63, 95% CI: 1.14-2.33). When stratified by race/ethnicity, among Hispanic women, those who utilized telehealth had greater odds of CC screening adherence compared to those who did not (aOR 2.83, 95% CI: 1.27-6.28). There were no significant associations between telehealth use and adherence to CC screening among other racial groups. Conclusions: Telehealth use was prevalent among US women and was associated with an increased likelihood of CC screening adherence, particularly among Hispanic women. These findings suggest that telehealth could be a significant tool in improving dwindling CC screening rates. Future research is also needed to explore the barriers to telehealth access to optimize its benefits among women eligible for CC screening.

Prevalence of Breast Cancer Screening in Asia: Systematic Review and Meta-Analysis.

Breast cancer is one of the leading causes of cancer-related mortality among women above 50 years of age. This systematic review and meta-analysis aimed at identifying the prevalence and trend of breast cancer screening among selected Asian countries. We searched three databases including, PubMed, Web of Science, and Scopus using our search terms. Two independent reviewers screened titles and abstracts applying the inclusion and exclusion criteria specified in the PROSPERO (registration ID: CRD42023401516) and any conflicts were resolved through discussion. Two independent reviewers and conflicts also completed the full-text screening, which was solved. Relevant information was extracted in an Excel sheet and random effects meta-analysis was performed to identify the pooled estimate of breast cancer screening in Asia using Stata 17. We identified 41 studies from 14 selected Asian countries reporting breast cancer screening rates from 2012-2023. The pooled estimate of four countries (China, Iran, Japan, and Korea) with more than three data points on clinical breast examination and mammographic screening showed a screening rate of 24% (95% CI: 0.20 - 0.27) and 18% (95% CI: (0.14 - 0.21) in the last ten years respectively. Most Asian countries do not have sufficient data on breast cancer screening due to a lack of nationally representative surveys or national-level cancer registries. Therefore, it is crucial to strengthen cancer control policies including breast cancer screening programs.

Clinical opinion spotlight: A sustainable model for improving access to mobile mammography for underserved populations

Minority women face disproportionately higher risks of breast cancer diagnosis and mortality under 50. Mobile mammography vans enhance screening accessibility but face challenges like long-term funding and operational viability. This study assesses existing mobile mammography van programs and proposes a sustainable model through literature review and qualitative interviews at a tertiary care academic medical center. The proposed model emphasizes partnerships, sponsorships and long-term funding for ensuring workforce sustainability. Organizational structure, budget allocation, patient workflow and follow-up protocols are aimed at transitioning towards serving primarily uninsured patients while maintaining financial stability. This sustainable approach hopes to enhance screening rates and timely care for underserved women, suggesting scalability and potential to reduce late-stage diagnoses and mortality. Continued implementation and evaluation are essential for validating feasibility and effectiveness, ensuring long-term improvement in screening rates and program longevity.

Implementation and improvement of a routine suicidal ideation screening process for an ambulatory, academic NCCN-designated center.

294 Background: From May – August 2021, outpatient suicidal ideation-related safety events nearly doubled from the three years prior at an academic NCCN center. This rise in events challenged staff and revealed improvement opportunities for suicide prevention, such as routine screening for suicidal ideation (SI) in the ambulatory setting. In addition, the COVID pandemic introduced an added layer of vulnerability to cancer patients, who are at an increased SI risk compared to the general population. Methods: From August 2021 - 2023, a multidisciplinary team developed and implemented a routine SI screening, intervention and escalation process that included a staff education program, a process-aligned EHR build, a metric dashboard, and a quality improvement-control plan. The vision was to identify all patients experiencing SI and support them with timely and compassionate care. A step-up metric target approach was used to set quarterly goals. The overarching goal was to screen at least 70% of eligible patients by the end of fiscal year 2024. The new process went live organization-wide on July 31, 2023. Following implementation, various improvement opportunities were identified with indicators including performance metrics, process audits, patient case reviews, and stakeholder feedback. Initial improvement efforts focused on clinics and sites that were screening &lt; 25% between FY24 Q1 and Q2. Continued collaboration between Quality Improvement and clinic leaders revealed improvement opportunities in identifying eligible patients and staff screening practices. Impactful interventions addressed patient identification and staff coaching. Results: As a new process, the overall screening rate started at 0% and increased to 48% over FY24*. Conclusions: Overall, a new SI screening process was successfully implemented, and improved with diligent PDSA work, yet metric goals were not achieved. Many factors may have contributed to underperformance. Ongoing evaluation and collaboration with stakeholders are crucial for continued improvement. Beyond these efforts exists the social and cultural stigma of suicide, which may have limited the impact of improvement endeavors. Results may demonstrate further need for open and supportive discussion with staff, patients, and the larger healthcare community. Data time range: 7/31/23-5/21/24.* FY24 + Quarter Metric Goal Screening Rate Q1 40% 35.7% Q2 50% 34.5% Q3 60% 41.2% Q4 70% 47.8%

A collaborator-engaged approach to tailoring strategies for implementing systematic health-related social needs assessment: Results from a cross-center study.

166 Background: Health-related social needs (HRSNs) exacerbate inequities in cancer incidence, morbidity and mortality. To improve health equity, policymakers recommend systematic HRSN screening in oncology clinics. In preliminary studies, we found low rates (&lt;10%) of HRSN screening in oncology. Building upon these findings and transdisciplinary expertise across four Implementation Science Centers in Cancer Control (ISC3), in the current study, we engaged oncology care teams in tailoring site-specific strategies to implement HRSN screening. Methods: Centers varied in collaborator engagement methods, including Context-Driven Co-Design (CD2), which aims to harmonize the intervention (i.e., HRSN screening), context (e.g., oncology clinic), and implementation strategies. First, site leads conducted semi-structured interviews with 8-10 care team members and clinic observations to identify current HRSN assessment processes and opportunities and barriers to systematic HRSN screening. Second, site leads engaged collaborators in one-on-one interviews or, when using CD2, in 3-4 iterative co-design workshops in which they used context assessment data and user-centered design activities (e.g., storyboarding) to prioritize contextual factors, identify necessary adaptations to HRSN screening, and co-design implementation strategies to address salient barriers. Centers met monthly to share knowledge and troubleshoot. Results: Most Centers’ oncology clinics had established informal HRSN screening approaches. Across Centers, collaborators (e.g., providers, nurses, medical assistants, patients) identified similar opportunities (e.g., desire for a standardized approach to HRSN screening; well-functioning clinical teams and physical space). Common challenges included limited familiarity with HRSN screening and documentation tools; lack of standardized screening protocol; and limited awareness of HRSN screening’s purpose. Implementation strategies included pencil-and-paper screening tools; clinic signage regarding HRSN screening’s purpose; training and creation of standardized screening protocol; and a centralized resource for responding to HRSN with adjustment, assistance, alignment, and/or advocacy. Conclusions: Four ISC3 Centers developed multicomponent implementation plans tailored to their oncology clinic. Centers’ varied approaches and timelines presented challenges and opportunities for cross-Center learning. Oncology clinics exhibited substantial overlap in opportunities and challenges in HRSN screening. Much of CD2’s benefits were related to its collaborator-driven approach to implementation strategy development. Next steps include deploying implementation plans and assessing their impact on equitable reach and adoption of HRSN screening and response to identified needs.

Insights into missing populations: Exploring characteristics of unscreened patients with cancer in psychosocial distress and social drivers of health screening in an ambulatory setting.

174 Background: Psychosocial distress is common among patients with cancer and distress screening is required for American College of Surgeons Commission on Cancer accreditation. Screenings proactively identify needs, connect patients to services, reduce distress and improve cancer outcomes. We implemented a dynamic 17-question electronic screening tool that includes: assessment for psychosocial distress, social drivers of health (SDH) and spiritual care, and evaluated differences in patient characteristics among those who did and did not complete the survey. Methods: The survey was developed through an interdisciplinary review of evidence-based questions to proactively address supportive care needs for patients. It is available in English and Spanish and sent to patients via the patient portal 7 days before the second oncology appointment with a reminder 3 days before the appointment. It was implemented across 5 Mount Sinai Health System ambulatory facilities, spanning 3 New York City boroughs between June 2022 and February 2024. We used descriptive statistics to compare demographic and clinical characteristics of patients who did and did not complete the survey. Results: A total of 11,199 patients were assigned surveys; (42%) did not complete it. Patients who did not complete the survey were more likely to be Asian and Hispanic, older age, to speak a language other than English, reside in Queens or Brooklyn, and were less likely to have Commercial insurance compared to those who completed the survey (p&lt;0.001 for all). There was no difference in sex (p=0.93) among the groups. Conclusions: There are significant disparities in the completion rates of electronic psychosocial distress and SDH screenings among patients with cancer, revealing that certain groups are less likely to engage with the tool. Targeted strategies are needed to increase screening completion rates among these populations. Future efforts should focus on addressing language barriers, enhancing technological accessibility, and developing culturally sensitive approaches to ensure all patients benefit from these screenings so we can better identify and address the supportive care needs of all cancer patients. Characteristics of patients who did and did not complete the survey. Characteristic Did Not Complete4654 (42%) Completed6545 (58%) p-value Race &lt;0.001 Black 978 (21) 1538 (23) Asian 642 (14) 698 (11) Unknown 225 (5) 258 (4) Other/Patient Declined 1298 (28) 1461 (22) White 1511 (32) 2590 (40) Age (mean (SD)) 64 (14) 61 (15) &lt;0.001 Non English Language 1167 (25) 956 (15) &lt;0.001

Special Education Law and Services for Pediatricians.

Rates of developmental screening have increased, and understanding how to discuss delays with families is imperative. Knowledge of federal and state law regarding special education is needed. Families often need support to understand the complexity of early intervention and school district-based services. The Individuals with Disabilities Education Act is the law that mandates services for children from birth to age 21 years who require them. Early intervention provides services for children age 0 to 3 years who have a delay or a condition with a high probability of delay. School-based services for children age 3 to 21 years provide children with disabilities with a free and appropriate public education in the least restrictive environment. While details of the laws are state and location specific, understanding the general principles of the law is important to support children and families navigate this very complex system and receive needed support. [Pediatr Ann. 2024;53(10):e366-e371.].

Adherence to pretreatment hepatitis B virus (HBV) screening in patients with cancer after implementation of built-in order set.

330 Background: Patients with a history of HBV exposure are at risk of reactivation when receiving treatments that affect the immune system, such as cancer-directed therapies. ASCO guidelines recommend universal HBV screening prior to initiation of cancer-directed therapies to prevent hepatic dysfunction and delays in cancer care. However, significant variation remains in clinical practice. Improving HBV screening is of special interest at our institution, given that we serve a large proportion of Asian immigrants at high risk of prior HBV exposure. With our institution’s transition to EPIC on Apr 1, 2022, the HBV serology order set was incorporated into the pre-treatment checklist of every cancer therapy plan. We studied the rates of HBV screening before and after implementing this change. Methods: We identified patients with cancer starting systemic cancer treatment at our institution between Oct 1, 2021 – Mar 31, 2022 (pre-EPIC period), and Oct 1, 2023 – Mar 31, 2023 (post-EPIC period). Patients who received only endocrine therapy, transferred care, or lost to follow-up prior to treatment initiation were excluded. To select a random sample from each time-period of interest, patients were assigned a random number, sorted based on this random number, and then reviewed in order. All data was collected retrospectively by manual chart review. Results: We randomly selected and reviewed 69 patients from pre-EPIC period, and 75 from post-EPIC period. Their demographic, disease, and treatment characteristics are summarized in the table. HBV screening rates were 42% and 80% in the pre-and post-EPIC periods, respectively (p&lt;0.001). Twenty-one (14.6%) patients screened positive for HBV core antibody, among whom six (5.1%) had negative surface antibodies. Conclusions: The built-in HBV serology order set significantly improved rates of hepatitis B screening prior to starting systemic cancer-directed treatment. It is a low-cost and highly effective intervention. Our next steps are to determine how a higher adherence to HBV screening guidelines impacted the management of patients with prior HBV exposure. Pre-EPIC:Oct 1, 2021 - Mar 31, 2022 (N=69) Post-EPIC: Oct 1, 2022 – Mar 31, 2023 (N=75) P values Age at diagnosis (years), mean (SD) 62.1 (1.4) 65.2 (1.6) 0.15 Female (%) 40 (58.0) 35 (46.7) 0.18 Race (%): 0.051 White 51 (73.9) 49 (65.3) Asian 8 (11.6) 20 (26.7) Other 10 (14.5) 6 (8.0) Cancer type (%): 0.39 Hematological Malignancies 19 (27.5) 16 (21.3) Solid Tumor 50 (72.7) 59 (78.7) Metastatic Disease (%) 24 (34.8) 25 (33.3) 0.95 Treatment Type (%): 0.13 CD20 mAb+/- other 3 (4.4) 9 (12.0) Chemotherapy+/-other 52 (75.4) 57 (76.0) Other 14 (20.3) 9 (12.0) mAb: monoclonal antibody.

S1753 The Catch Up: Improving Hepatitis B Screening and Vaccination Rates Among High-Risk Ethnic Minorities

S1753 The Catch Up: Improving Hepatitis B Screening and Vaccination Rates Among High-Risk Ethnic Minorities

The Cancer Equity Compass: Interactive maps showing the association between social determinants of health and cancer disparities.

149 Background: Cancer incidence and mortality in Black, Hispanic and Native American populations is over twice that in the White population for some prevalent cancers. A new, publicly available mapping tool, the Cancer Equity Compass (CEC), was developed to inform data-driven initiatives to improve equity by identifying community factors associated with cancer disparities. The tool is comprised of interactive maps that visually reveal correlations between two variables. Development of the tool began with assembling a group of nine advisors with expertise in cancer prevention, treatment and health equity. These experts inform the strategy, data sources, variables of interest, and stakeholder value propositions for the CEC. Methods: The data source for the CEC is a national, multi-level database developed using individual, health system, and community data, aggregated by county. For the three most common cancers in the U.S., breast, prostate and lung, screening and prevalence rates were collected from 2021 Medicare 5% research identifiable files and mortality rates from 2020 SEER Medicare rates. These metrics were each mapped with a variety of social determinants of health (SDOH) variables. Population rates for minorities, education, poverty, income and unemployment, and an air quality measure were from the Area Health Resources File. Environmental risks were derived from the Environmental Justice Index and included environmental burden (ranked 0-17 for pollution, toxic sites, built environment, transportation infrastructure and water pollution), air pollution (ranked 0-4), and social vulnerability (ranked 0-14 across socioeconomic variables). Results: Each map includes one cancer metric and one SDOH variable. Each variable is stratified to show the top quartile, middle 50%, and bottom quartile. The choropleth heat maps, created on Tableau, display 9 colors representing each combination of the three levels (&gt;75%, 25-75%, &lt;25%) for both mapped variables. The CEC currently has 140 maps presenting visualizations of county SDOH associations with cancer disparities. Conclusions: The expert advisors on the project have outlined four avenues for the CEC to aid efforts to improve cancer equity: 1) Enhance diversity in clinical trial recruitment and data registries through targeted site recruitment; 2) Identify high opportunity targets for improving equity and informing solutions; 3) Identify common correlates of disparities within and across U.S. counties to direct priorities for national policy and programs for large-scale impact; and 4) Measure change to support improvement efforts and report impact of equity initiatives. The CEC will be expanded with additional measures including healthcare access. The goal is use by stakeholders and changemakers who can apply the reported data to fuel advocacy efforts and enact positive change.

S464 From Awareness to Action: How a New Jersey based FQHC Doubled Colorectal Cancer Screening Rates

S464 From Awareness to Action: How a New Jersey based FQHC Doubled Colorectal Cancer Screening Rates

6500 Screening Rates in Emerging Adults With Cystic Fibrosis for Cystic Fibrosis-Related Bone Disease: A Retrospective Cohort Study

6500 Screening Rates in Emerging Adults With Cystic Fibrosis for Cystic Fibrosis-Related Bone Disease: A Retrospective Cohort Study

Getting a colonoscopy at The Valley Hospital.

71 Background: Colorectal cancer (CRC) is the 3rd most common cancer in the U.S., yet it is preventable with evidence-based strategies such as early screening. The Valley Hospital (TVH) located in Bergen County NJ, is recognized for its high insured payer mix and median household income. According to the 2016 TVH Community Health Needs Assessment, only 71.4% of patients in TVH service area have had a CRC screening. The American Cancer Society National Colorectal Cancer Roundtable (NCCRT) campaigned to reach CRC screening rates of 80% and higher in communities across the nation. The Fast Track Screening Colonoscopy Program (FTSCP) at TVH was created to streamline the process of obtaining a screening colonoscopy and reach the NCCRT’s goal. Through the FTSCP, patients can omit the initial consultation with a gastroenterologist or colorectal surgeon. Patients are instead screened via a telephone call by a Physician Assistant (PA) or Advanced Practice Nurse (APN). The FTSCP is cost effective for patients as it potentially eliminates the initial consultation copayment and/or coinsurance. Methods: The purpose of the FTSCP is to achieve the NCCRT’s 80% goal of CRC screenings in TVH service area. An interdisciplinary team of gastroenterologists, colorectal surgeons, oncologists, anesthesiologists, and administration collaborated to create the FTSCP. A screening questionnaire was developed using the Lincoln Hospital in NYC’s existing criteria for patients who are eligible for a direct endoscopy referral. The questionnaire criteria ensures patients are safe to eliminate the initial consultation. A PA or APN determines the patients’ eligibility for the FTSCP over a screening telephone call. To qualify, patients cannot have significant medical comorbidities or exhibit signs or symptoms of CRC. If deemed eligible, the PA or APN sends a bowel preparation prescription to the patient’s pharmacy, reviews the instructions with them, and meets with them on the day of the procedure at TVH to perform a pre-procedural physical exam. To promote awareness and education of the FTSCP, multiple ongoing outreach events are held in the community. Patients also learn about the FTSCP through primary and specialty care referrals. Results: Since the inception of FTSCP in 2018, over 1300 patients have been screened for CRC. Additionally, adenocarcinomas, carcinoid tumors and tubular adenomas with high grade dysplasia have been detected. 394 tubular adenomas (30%) were identified and removed. In 2018, 59 patients were screened. The number of patients increased by 500% to 296 in 2023. The 2022 TVH Community Health Needs Assessment showed an increase to 79.6% of patients in TVH service area who have undergone CRC screening. Conclusions: The FTSCP at TVH is maximizing patient’s access to the prevention and timely screening for CRC. Additionally, TVH’s relocation from Ridgewood, NJ to Paramus, NJ offers further opportunities to educate a new community on CRC prevention.

Uncovering the hidden burden: A mixed methods study on the implementation of depression screening among persons with type 2 diabetes mellitus seeking health care in an urban primary health center of South India

BACKGROUND: Diabetes is linked with depression, but screening rates for depression are low, indicating a need for periodic assessments among those with diabetes. The study aimed to determine depression prevalence and associated factors in persons with type 2 diabetes mellitus (T2DM) in an urban primary care setting of Karnataka, as well as implementation challenges in depression screening for persons with T2DM as perceived by healthcare providers. MATERIAL AND METHODS: A mixed-methods study was performed for 6 months in 2022–2023 at an Urban Primary Health Centre (UPHC) in Bengaluru. The sample size was calculated to be 110, and convenience sampling was applied to select persons with T2DM. The participants were screened for depression using Patient Health Questionnaire-9. Key informant interviews were performed among various health care providers of the UPHC. Data were captured using EpiCollect Version 5.0. Univariate logistic regression was performed to find the factors associated with depression. RESULT: Of the 110 participants, 60 (54.5%) screened positive for depression. Men had 0.474 (95% Confidence Intervals—CI: 0.126, 1.782) lesser odds of depression when compared with women (P = 0.269). Those with comorbidities had 1.975 more odds (95% CI: 0.538, 7.252) when compared with absence of comorbidities (P = 0.305). Statistically significant associations were not found with any of the factors. Key facilitators for screening were willingness to implement screening, empathetic attitude, and awareness of mental health, whereas the challenges included lack of training in mental health assessment and patient reluctance to adhere to treatment due to stigma. CONCLUSION: The study found that 54.5% of persons with T2DM seeking heath care at the UPHC screened positive for depression. Several challenges in implementing depression screening for T2DM in primary care settings were noted.

S468 Improving FITness: Increasing Colorectal Cancer Screening Rates in Average-Risk Veterans Aged 45-49 in Southeast Louisiana

S468 Improving FITness: Increasing Colorectal Cancer Screening Rates in Average-Risk Veterans Aged 45-49 in Southeast Louisiana

Leveraging a geographic information system (GIS) to identify lung cancer care disparities and opportunities in rural Appalachia.

78 Background: The Rural Appalachian Lung Cancer Screening Initiative is led by the Association of Cancer Care Centers (ACCC) and patient advocacy partners. Recognized by the White House Cancer Moonshot, this initiative seeks to improve lung cancer screening rates by partnering with health systems in rural Appalachia to develop and implement interventions. An 11-county region bordering West Virginia, Virginia, and Kentucky has significantly higher mortality and lung cancer incidence rates than the national rates of 35.0 and 54.0 per 100,000 people, respectively (Table 1). This region was identified as the focus area for the initiative with participation from health systems in Pike County, KY, and Buchanan County, VA. Methods: To understand availability of local resources, ACCC developed an interactive GIS tool that identifies screening and referral locations as well as essential services in the region. Lung cancer screening sites, oncology services, mammography locations, critical access hospitals, NCI-designated cancer centers, federally qualified health centers (FQHCs) and look-alikes, rural health clinics, and primary care/general health services were identified from publicly available data and data requested from state departments of health. Facilities were contacted to verify services when unclear. STATA 18 was used to combine and clean data for upload to Google MyMaps, creating an interactive map. Results: Of the 11 counties, all contain at least 1 FQHC or primary care site. However, 5 of the counties do not have lung cancer screening sites and 7 of the counties do not have oncology service sites (Table). The closest NCI-designated cancer centers to the participating sites are over 140 miles away. Conclusions: While there is a notable presence of primary care, access to lung cancer screening and oncology care is limited. Sites can utilize this map to inform development of interventions by considering potential geographical challenges, identifying referral sites, outreach opportunities, and partners to facilitate lung cancer screening and education. Further, these methods are replicable, and can be used to inform current access to care and improve equitable delivery of lung cancer screening in regions across the U.S. Distribution of lung cancer mortality, incidence, and infrastructure within initiative focus region. Region Mortality*(per 100,000) Incidence*(per 100,000) # Lung Cancer Screening Sites # Oncology Services Sites KY (1 county) 70 109.3 2 2 VA (6 counties) 45.0 – 61.4 42.9 – 68.6 4 3 WV (4 counties) 57.6 – 74.8 100.4 – 111.5 1 0 *Lung &amp; Bronchus, 2016-2020 age-adjusted death rates (KY, VA, WV) and incidence rates (KY, WV). Lung &amp; Bronchus, 2015-2019 age-adjusted incidence rate (VA). Source: statecancerprofiles.cancer.gov.