serving as chair of the Medicare Payment Advisory Commission; and that he is a partner in, and holds equity in, V-BID Health Equity.
INTRODUCTION: Recent studies indicate low rates of follow-up colonoscopy after abnormal fecal immunochemical testing (FIT) within safety net health systems. A patient navigation (PN) program is an evidence-based strategy that has been shown to improve colonoscopy completion in private and public healthcare settings. The aim of this study was to evaluate the effectiveness of a PN program to encourage follow-up colonoscopy after abnormal FIT within a large safety net hospital system. METHODS: We established an enterprisewide PN program at 5 tertiary care hospitals within the Los Angeles County Department of Health Services system in 2018. The PN assisted adult patients aged 50–75 years with an abnormal FIT to a follow-up colonoscopy within 6 months. PN activities included initiating referral for and scheduling of colonoscopy, performing reminder phone calls to patient for their upcoming colonoscopy, and following up with patients who did not attend their colonoscopy. We assess the effectiveness of the PN intervention by comparing follow-up colonoscopy rates with a period before the intervention. RESULTS: There were 2,531 patients with abnormal FIT results (n = 1,214 in 2017 and n = 1,317 in 2018). A majority were women (55% in 2017 vs 52% in 2018) with a mean age of 60 ± 6.2 years. From a previous mean of 163 days without PN in 2017, the mean time from abnormal FIT to colonoscopy with PN improved to 113 days in 2018. The frequency of colonoscopy completion with PN increased from 40.6% (n = 493) in 2017 to 46% (n = 600) in 2018. DISCUSSION: After the introduction of the PN program, there was a significant increase in patients undergoing follow-up colonoscopy after abnormal FIT and patients were more likely to undergo colonoscopy within the recommended 6 months.
We evaluate National Cancer Institute (NCI) funding distribution to the most common cancers, considering their respective public health burdens and explore associations between funding and racial/ethnic burden of disease. The NCI’s Surveillance, Epidemiology and End Results (SEER), United States Cancer Statistics (USCS) database, and Funding Statistics were used to calculate funding-to-lethality (FTL) scores. Breast and prostate cancer had the 1st (179.65) and 2nd (128.90) highest FTL scores while esophagus and stomach cancer ranked 18th (2.12) and 19th (1.78). We evaluated whether there were differences between the FTL and cancer incidence and/or mortality within individual racial/ethnic groups. NCI funding correlated highly with cancers afflicting a higher proportion of non-Hispanic whites (Spearman Correlation Coefficient = 0.84, p < .001). Correlation was stronger for incidence than mortality. These data reveal that funding across cancer sites is not concordant with lethality and that cancers with high incidence among racial/ethnic minorities receive lower funding.
INTRODUCTION: More effective strategies are needed to improve the rate of colorectal cancer (CRC) screening among safety-net populations. The Fecal Immunochemical Test (FIT), a low-cost screening tool, is the primary modality for CRC screening at our safety net hospital. Institutional data demonstrated a poor FIT return rate of 20% within 4-6 weeks. In a study assessing barriers to FIT completion, we found that survey respondents preferred completing the FIT on the same day as their clinic appointment. This key result informed the development of a same day FIT intervention of our current study. Here we present the interim results. METHODS: We designed and implemented an early FIT return strategy called “Go Before You Go” within the primary care clinic. Our team met with stakeholders involved with CRC screening, including clinic leadership, nursing staff, and resident physicians. Patients were encouraged to complete the FIT in-office during their primary care visit. If patients were unable to provide their sample on the same day, then they were encouraged to return the test within one week of when the test was ordered. Resident physicians and nursing staff were counseled to encourage this policy via brief didactic sessions and reminded at daily huddles and through weekly text reminders. Television monitors in the clinic waiting room displayed ads for ”Go Before You Go.” RESULTS: We report the frequency of FIT completion before and after the intervention. Prior to the intervention, the total number of FITs ordered from January to March 2019 was 1444. The baseline same-day FIT return rate was 5.0% (n = 72), the 1-week return rate was 11.1% (n = 160), and the 4-week return rate was 20.6% (n = 297). Interim analysis of data one month after the introduction of the intervention demonstrated an overall improvement in the FIT return rate. A total of 488 FITs were ordered in April 2019. During the intervention period, the same-day FIT return rate increased to 12.7% (n = 62), the 1-week rate was 20.1% (n = 98) and the 4-week return rate was 29.9% (n = 146). CONCLUSION: Interim analysis from an ongoing “Go Before You Go” strategy resulted in an overall increase in the same-day, 1-week, and 4-week FIT completion rate in a safety net primary care clinic. This innovative approach to CRC screening shows promise; the intervention is thus ongoing and FIT return rates continue to be monitored for sustained improvement.
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