Faecal immunochemical testing implementation to increase colorectal cancer screening in primary care

Abstract

Colorectal cancer (CRC) is the second leading cause of cancer death in USA, and CRC screening remains suboptimal. The aim of this quality improvement was to increase CRC screening in the internal medicine clinic (IMC) patients, between the ages of 50–75 years, from a baseline rate of 50%–70% over 12 months with the introduction of faecal immunochemical test (FIT) testing. We used the Plan–Do–Study–Act (PDSA) method and performed a root cause analysis to identify barriers to acceptance of CRC screening. The quality improvement team created a driver diagram to identify and prioritise change ideas. We developed a process flow map to optimise opportunities to improve CRC screening. We performed eight PDSA cycles. The major components of interventions included: (1) leveraging health information technology; (2) optimising team work, (3) education to patient, physicians and IMC staff, (4) use of patient navigator for tracking FIT completion and (5) interactive workshops for the staff and physicians to learn motivational interview techniques. The outcome measure included CRC screening rates with either FIT or colonoscopy. The process measures included FIT order and completion rates. Data were analysed using a statistical process control and run charts. Four hundred and seven patients visiting the IMC were offered FIT, and 252 (62%) completed the test. Twenty-two (8.7%) of patients were FIT positive, 14 of those (63.6%) underwent a subsequent diagnostic colonoscopy. We achieved 75% CRC screening with FIT or colonoscopy within 12 months and exceeded our goal. Successful strategies included engaging the leadership, the front-line staff and a highly effective multidisciplinary team. For average-risk patients, FIT was the preferred method of screening. We were able to sustain a CRC screening rate of 75% during the 6-month postproject period. Sustainable annual FIT is required for successful CRC screening.

Disparities in outcomes among patients diagnosed with cancer associated with emergency department visits

“…29,30 Intervening on this population is challenging but supported by a Cochrane Review, guaiac fecal immunochemical test (FIT) can reduce colorectal mortality by 15%, and providing appropriately chosen patients with home use FIT tests through primary care has improved screening rates, sustaining a screening rate of 75%. 31,32 Currently screening routinely for cancer does not occur in the emergency setting, but for many vulnerable patients (uninsured, lower SES, racial minorities), the emergency room serves as the only opportunity for routine care and we should begin to explore alternative strategies to maximally improve the care of these patients. 33 Removing the barriers to cancer screening, such as providing patients with FIT cards prior to discharge may represent an opportunity to increase adherence to CRC screening and reduce the burden of emergently diagnosed CRC.…”

Team-Based Primary Care Practice Transformation Initiative and Changes in Patient Experience and Recommended Cancer Screening Rates

“…Some team-based primary care interventions have improved colorectal cancer screening rates using innovative strategies, including the use of community health worker outreach and the introduction of fecal immunochemical tests; however, these practices had lower baseline rates than AIC practices, which exceeded the national average among commercially insured patients in 2013 (approximately 60%). 48 - 50 There is mixed evidence on the association between breast cancer screening rates and team-based care: 1 study reported significant improvements of 3.5 percentage points over 3 years in practices with care teams, while another found no significant changes. 51 , 52 Fewer studies have examined changes in cervical cancer screening rates associated with adoption of team-based care, though 1 found no significant differences among army primary care patients following the formation of care teams.…”

Comparison of Quality Performance Metrics in Screening and Surveillance Colonoscopy: A Single-Center Experience

“…However, as the entry age for CRC screening has recently been lowered to include those aged 45 years and older, and while alternatives such as the fecal immunochemical test (FIT) are becoming increasingly popular, it is reasonable to suspect that there will be larger demand for surveillance colonoscopies compared to screening colonoscopies in the near future [18][19]. In light of this, we should anticipate a larger volume of surveillance procedures and establish appropriate benchmarks to ensure quality surveillance colonoscopy performance and to improve detection rates of interval CRC.…”