Kevin Selby1, Carlo Senore2, Martin Wong3, Folasade P May4, Samir Gupta5, Peter S Liang6. 1. Center for primary care and public health (Unisanté), University of Lausanne, Lausanne, Switzerland. 2. Epidemiology and screening unit - CPO, University Hospital Citta` della Salute e della Scienza, Turin, Italy. 3. Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong. 4. Vatche and Tamar Manoukian Division of Digestive Diseases, Jonsson Comprehensive Cancer Center, Department of Medicine, University of California, Los Angeles, CA, USA. 5. VA San Diego Healthcare System, San Diego, CA and Division of Gastroenterology and the Moores Cancer Center, UC San Diego, La Jolla, CA, USA. 6. Division of Gastroenterology, Department of Medicine, NYU Langone Health, New York, NY, USA.
Abstract
OBJECTIVE: Colorectal cancer screening programs frequently report problems ensuring adequate follow-up of positive fecal immunochemical tests (FITs). We investigated strategies implemented by ongoing screening programs to improve follow-up for FIT-positive participants, and explored associations between interventions and reported rates of follow-up. METHODS: We submitted an electronic survey to 58 colorectal cancer screening programs or affiliated researchers. Primary outcomes were the proportion of program participants with a positive FIT completing diagnostic colonoscopy, and patient, provider, and system-level interventions used to improve follow-up. We compare mean colonoscopy completion at six months in programs with and without interventions. RESULTS: Thirty-five programs completed the survey (60% response). The mean proportion of participants with a positive FIT who completed colonoscopy was 79% (standard deviation 16%). Programs used a mean of five interventions to improve follow-up. Programs using patient navigators had an 11% higher rate of colonoscopy completion at six months (p = 0.05). Programs sending reminders to primary care providers when no colonoscopy has been completed had a 12% higher rate of colonoscopy completion (p = 0.03). Other interventions were not associated with significant differences. CONCLUSIONS: Almost all programs employ multiple interventions to ensure timely follow-up of positive FIT. The use of patient navigators and provider reminders is associated with higher rates of colonoscopy completion.
OBJECTIVE: Colorectal cancer screening programs frequently report problems ensuring adequate follow-up of positive fecal immunochemical tests (FITs). We investigated strategies implemented by ongoing screening programs to improve follow-up for FIT-positive participants, and explored associations between interventions and reported rates of follow-up. METHODS: We submitted an electronic survey to 58 colorectal cancer screening programs or affiliated researchers. Primary outcomes were the proportion of program participants with a positive FIT completing diagnostic colonoscopy, and patient, provider, and system-level interventions used to improve follow-up. We compare mean colonoscopy completion at six months in programs with and without interventions. RESULTS: Thirty-five programs completed the survey (60% response). The mean proportion of participants with a positive FIT who completed colonoscopy was 79% (standard deviation 16%). Programs used a mean of five interventions to improve follow-up. Programs using patient navigators had an 11% higher rate of colonoscopy completion at six months (p = 0.05). Programs sending reminders to primary care providers when no colonoscopy has been completed had a 12% higher rate of colonoscopy completion (p = 0.03). Other interventions were not associated with significant differences. CONCLUSIONS: Almost all programs employ multiple interventions to ensure timely follow-up of positive FIT. The use of patient navigators and provider reminders is associated with higher rates of colonoscopy completion.
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