243  An Interim Analysis of a Patient Navigation Program (PNP) to Improve Colonoscopy Access After Abnormal FIT

Abstract

INTRODUCTION: Colorectal cancer (CRC) is a leading cause of cancer mortality despite being largely preventable. The fecal immunochemical test (FIT) is a recommended screening method, but timely evaluation of abnormal results is critical to the effectiveness of CRC screening. Recent studies indicate low rates of follow up colonoscopy after abnormal FIT within safety net health systems. A patient navigator program (PNP) is an evidence based strategy that has been shown to improve colonoscopy completion. The aim of this study was to evaluate the effectiveness of a PNP to encourage follow up colonoscopy after abnormal FIT within a large safety net hospital system. METHODS: We established an enterprise-wide PNP at five tertiary care hospitals within the Los Angeles County Department of Health Services (LAC-DHS) system. Patients 50–75 years of age with an abnormal FIT result were assisted by the PNP to complete their follow up colonoscopy within 6 months. Here we perform an interim analysis of a prospective cohort of patients from June 1, 2018 to December 31, 2018 assisted by the PNP. We compare the effectiveness of the PNP intervention by comparing colonoscopy rates to a period prior to the intervention. We also summarize the endoscopic findings of patients undergoing colonoscopy. RESULTS: Among 1217 patients with abnormal FIT results, 43% (n = 546) were men with a mean age of 60.3 ± 6.2 years. From a previous baseline of 167 days (SD 118), the mean time from abnormal FIT to colonoscopy improved to 117 days (SD 53) with navigation. The frequency of colonoscopy completion increased in patients who received navigation (53%, n = 642) as compared to patients who did not receive navigation (40.5%, 492/1213). Among PNP patients undergoing colonoscopy (N = 642), 50.2% (n = 322) had adenomatous polyps, 24% (n = 156) had “high risk” adenomas, and 2% (n = 12) had CRC. CONCLUSION: After the introduction of a patient navigator program, there was an overall increase in patients undergoing follow-up colonoscopy after abnormal FIT within a shorter time interval. Over half of the patients undergoing colonoscopy were found to have clinically significant findings including high risk adenomas and CRC. In this interim analysis, we demonstrate that the integration of a patient navigator program for CRC screening may be instrumental in increasing adherence to recommended screening guidelines across a large safety net health system.