Abnormal Colorectal Cancer Test Follow-Up: A Quality Improvement Initiative at a Federally Qualified Health Center.

IF 3 Q1 PRIMARY HEALTH CARE Journal of Primary Care and Community Health Pub Date : 2024-01-01 DOI:10.1177/21501319241242571
Faizah Shareef, Balambal Bharti, Felipe Garcia-Bigley, Monica Hernandez, Jesse Nodora, Jie Liu, Christian Ramers, Jill Dumbauld Nery, Jessica Marquez, Karina Moyano, Sarah Rojas, Elva Arredondo, Samir Gupta
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Abstract

Introduction/objectives: Colonoscopy completion rates after an abnormal fecal immunochemical test (FIT) are suboptimal, resulting in missed opportunities for early detection and prevention of colorectal cancer. Patient navigation and structured follow-up may improve colonoscopy completion, but implementation of these strategies is not widespread.

Methods: We conducted a quality improvement study using a Plan-Do-Study-Act (PDSA) Model to increase colonoscopy completion after abnormal FIT in a large federally qualified health center serving a diverse and low-income population. Intervention components included patient navigation, and a checklist to promote completion of key steps required for abnormal FIT follow-up. Primary outcome was proportion of patients achieving colonoscopy completion within 6 months of abnormal FIT, assessed at baseline for 156 patients pre-intervention, and compared to 208 patients during the intervention period from April 2017 to December 2019. Drop offs at each step in the follow-up process were assessed.

Results: Colonoscopy completion improved from 21% among 156 patients with abnormal FIT pre-intervention, to 38% among 208 patients with abnormal FIT during the intervention (P < .001; absolute increase: 17%, 95% CI: 6.9%-25.2%). Among the 130 non-completers during the intervention period, lack of completion was attributable to absence of colonoscopy referral for 7.7%; inability to schedule a pre-colonoscopy specialist visit for 71.5%; failure to complete a pre-colonoscopy visit for 2.3%; the absence of colonoscopy scheduling for 9.2%; failure to show for a scheduled colonoscopy for 9.2%.

Conclusions: Patient navigation and structured follow-up appear to improve colonoscopy completion after abnormal FIT. Additional strategies are needed to achieve optimal rates of completion.

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结直肠癌检测异常随访:联邦合格医疗中心的质量改进计划。
导言/目标:粪便免疫化学检验(FIT)异常后的结肠镜检查完成率并不理想,导致错失早期发现和预防结直肠癌的机会。患者导航和结构化随访可提高结肠镜检查的完成率,但这些策略的实施并不普遍:我们采用 "计划-实施-研究-行动"(Plan-Do-Study-Act,PDSA)模式开展了一项质量改进研究,目的是在一家大型联邦合格医疗中心提高 FIT 异常后结肠镜检查的完成率。干预措施包括为患者提供指导,以及使用检查表促进完成 FIT 异常随访所需的关键步骤。主要结果是在 FIT 异常后 6 个月内完成结肠镜检查的患者比例,在干预前对 156 名患者进行基线评估,并与 2017 年 4 月至 2019 年 12 月干预期间的 208 名患者进行比较。对随访过程中每一步的辍学情况进行了评估:结肠镜检查完成率从干预前 156 名 FIT 异常患者中的 21% 提高到干预期间 208 名 FIT 异常患者中的 38%(P 结论:患者导航和结构化随访似乎有助于提高结肠镜检查完成率:患者指导和结构化随访似乎能提高 FIT 异常后结肠镜检查的完成率。要达到最佳完成率,还需要其他策略。
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来源期刊
CiteScore
4.80
自引率
2.80%
发文量
183
审稿时长
15 weeks
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