Practice Management

39 - Delineating Deficiencies in Care Processes After Positive Fecal Immunochemical Test Results

Tuesday, October 9
2:35 PM - 2:45 PM
Location: Terrace Ballroom 4 (level 400)

Category: Practice Management
Christine Yu, MD1, Vivy Tran, MD1, Liu Yang, MD1, Tina Storage, MD2, Frank W. Chen, MD1, Folasade P. May, MD, PhD2
1David Geffen School of Medicine at UCLA, Los Angeles, CA; 2University of California Los Angeles, Los Angeles, CA

Introduction: Failure to complete diagnostic colonoscopy after a positive fecal immunochemical test (FIT) undermines the value of the test for colorectal cancer (CRC) screening. Nonetheless, colonoscopy uptake after positive FIT is suboptimal in many healthcare settings. Limited data describe challenges in the clinical care pathways required for diagnostic colonoscopy completion. The aim of our study was to identify deficiencies in care processes required to achieve colonoscopic follow-up after positive FIT in a large academic clinical setting.

Methods: We identified a cohort of subjects with at least one positive FIT result between 1/1/2015 and 10/31/17 in a tertiary care integrated health system. All subjects were age 50 to 75 and at average risk for CRC. We extracted demographic and clinical data for all subjects. We then performed manual chart review to determine completion status for each step in the clinical pathway for diagnostic follow-up after positive FIT (Figure). We determined the proportion of patients that completed colonoscopy and the proportion of FIT-positive patients that completed each clinical step. We also used Student’s t-tests and chi-square tests to evaluate univariate associations between patient characteristics and completion of colonoscopy. Patients with missing data were excluded from analyses.

Results: There were 358 subjects with a positive FIT during the study period, and 188 (52.5%) completed a diagnostic colonoscopy. Demographic characteristics were similar among those that did and did not complete a colonoscopy (Table). Primary care providers acknowledged 323 (90.2%) positive FIT results. Of these, 202 (62.5%) were referred for gastroenterology (GI) clinic evaluation, and 76 (23.5%) were referred directly for a colonoscopy. Of those that were referred for GI clinic evaluation (n=202), 157 (77.7%) were evaluated and 118 (58.4%) completed colonoscopy. In comparison, 63 (82.9%) of the 76 patients referred directly to colonoscopy completed the procedure (Figure).

Discussion: There are multiple clinical steps required to achieve diagnostic colonoscopy after a positive FIT. We found that 1) subject attrition is affected at each step in the process, and 2) the largest loss of attrition occurs when a GI clinic evaluation precedes colonoscopy. Future work will determine factors that necessitate GI clinic evaluation prior to colonoscopy and develop interventions to improve colonoscopy rates after positive FIT.

Clinical Pathway for Diagnostic Follow-up After Positive FIT; N=358 N= (# patients who completed clinical step) / (# of patients who completed prior step)
Table: Patient characteristics by colonoscopy completion status, N=358

Disclosures:
Christine Yu indicated no relevant financial relationships.
Vivy Tran indicated no relevant financial relationships.
Liu Yang indicated no relevant financial relationships.
Tina Storage indicated no relevant financial relationships.
Frank Chen indicated no relevant financial relationships.
Folasade May indicated no relevant financial relationships.

Vivy Tran


California

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39 - Delineating Deficiencies in Care Processes After Positive Fecal Immunochemical Test Results



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