Standardized Workflows Improve Colonoscopy Follow-Up After Abnormal Fecal Immunochemical Tests in a Safety-Net System

Abstract

Background How clinical teams function varies across sites and may affect follow-up of abnormal fecal immunochemical test (FIT) results. Aims This study aimed to identify the characteristics of clinical practices associated with higher diagnostic colonoscopy completion after an abnormal FIT result in a multi-site integrated safety-net system. Methods We distributed survey questionnaires about tracking and follow-up of abnormal FIT results to primary care team members across 11 safety-net clinics from January 2017 to April 2017. Surveys were distributed at all-staff clinic meetings and electronic surveys sent to those not in attendance. Participants received up to three reminders to complete the survey. Results Of the 501 primary care team members identified, 343 (68.5%) completed the survey. In the four highest-performing clinics, nurse managers identified at least two team members who were responsible for communicating abnormal FIT results to patients. Additionally, team members used a clinic-based registry to track patients with abnormal FIT results until colonoscopy completion. Compared to higher-performing clinics, lower-performing clinics more frequently cited competing health issues (56% vs. 40%, p = 0.03) and lack of patient priority (59% vs. 37%, p < 0.01) as barriers and were also more likely to discuss abnormal results at a clinic visit (83% vs. 61%, p < 0.01). Conclusions Our findings suggest organized and dedicated efforts to communicate abnormal FIT results and track patients until colonoscopy completion through registries is associated with improved follow-up. Increased utilization of electronic health record platforms to coordinate communication and navigation may improve diagnostic colonoscopy rates in patients with abnormal FIT results.

An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees

“…Katz et al found that fully staffed teams are able to reconfigure roles and responsibilities and potentially develop new workflow processes [37]. Issaka and colleagues reported that having at least two members, and mostly MAs and nurses, communicate abnormal results to patients resulted in higher diagnostic colonoscopy completion [38]. Results of our matrix analysis further support the importance of engaging support staff in communication results.…”

“…These findings on communication and interactions from MA's and nurses highlight the importance of team-based care in primary care. Studies have found a positive association between team-based care and strategies that promote patient engagement [37] and better health outcomes [38]. Katz et al found that fully staffed teams are able to reconfigure roles and responsibilities and potentially develop new workflow processes [37].…”

Colorectal Cancer Screening and Prevention in the COVID-19 Era

“…Create workflows to track patients with abnormal FIT results until colonoscopy is completed. 5 4. Increase gastroenterology staffing to accommodate the expected surge in procedural demand.…”

Systematic Review of Interventions to Increase Stool Blood Colorectal Cancer Screening in African Americans

“…CRC screening may also involve annual stool blood tests, such as the FIT or gFOBT, and follow-up with diagnostic colonoscopy if needed for abnormal findings. Communication of abnormal FIT results are associated with improved adherence to follow-up colonoscopy [6].…”