Annual Scientific Meeting
Introduction: Annual fecal immunochemical test (FIT) is a non-invasive screening method recommended for individuals at average risk of colorectal cancer (CRC). Lack of FIT orders is perceived as a barrier to complete CRC screening. We aimed to evaluate bulk ordering FIT as a population health level methodology in improving CRC screening rates.
Methods: Individuals 50-75 years old, who visited a primary care provider (PCP) in the MetroHealth System within the preceding 2 years were reviewed between 10/2018 and 04/2019. Individuals at average-risk of CRC who neither completed FIT in the preceding 11 months nor were assigned to the colonoscopy screening track were identified via querying of the electronic health record (EHR). Bulk orders were placed on eligible individuals once a month, using PCP as the authorizing provider or residency program director for residents. Individuals were informed of the order via the most appropriate channel: personal health record message (MyChart), email, or secure text message mediated by third-party texting services (Clintell). An automated daily process canceled any obsolete bulk FIT orders when patients turned 76 years old, switched to colonoscopy track, or had another FIT order resulted. FIT orders were released when the patient visited the clinic or requested the kit to be mailed. Individuals with a positive FIT were contacted by designated staff to schedule a follow-up colonoscopy. FIT numbers at each step of the bulk order method were compared to regular orders in usual care (FIT orders placed by a provider during an outpatient visit) to analyze differences in outcome.
Results: From 10/2018 to 04/2019, 27,212 bulk orders and 13,756 regular orders were placed. Only 8.5% of bulk orders were released compared to regular orders (91.6%) but the released orders were completed at similar rates in either group. Among those with a positive FIT, a significantly higher number had a follow-up colonoscopy within 120 days in the bulk order (67.8%) compared to usual care (53.2%), p = 0.04. 33.9% of positive bulk FIT detected an adenoma compared to 29.5% of positive routine care FIT, p = 0.50.
Discussion: Managing FIT at population health level provides a time-efficient way to identify patients due for CRC screening in an urban safety-net hospital. Bulk ordering bypasses the need for a PCP encounter for order placement. Bulk ordering FIT has shown better follow up rates compared to the traditional method and may ultimately improve CRC detection.