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

Area of Science:

• Oncology
• Public Health
• Healthcare Quality Improvement

Background:

• Colorectal cancer (CRC) is a leading cause of cancer death in the USA, with suboptimal screening rates.
• Improving CRC screening is crucial for early detection and reducing mortality.

Purpose of the Study:

• To increase CRC screening rates in internal medicine clinic (IMC) patients aged 50-75 years from 50% to 70% within 12 months.
• To implement and evaluate the effectiveness of faecal immunochemical test (FIT) introduction and a quality improvement initiative.

Main Methods:

• Utilized the Plan-Do-Study-Act (PDSA) method and root cause analysis to identify barriers to CRC screening.
• Implemented interventions including health IT, team optimization, patient/physician education, patient navigators, and motivational interviewing workshops.
• Monitored CRC screening rates (FIT or colonoscopy) and FIT completion rates using statistical process control and run charts.

Main Results:

• Achieved a 75% CRC screening rate within 12 months, exceeding the 70% goal.
• 252 out of 407 (62%) patients completed FIT; 22 (8.7%) were FIT positive, with 14 (63.6%) undergoing diagnostic colonoscopy.
• Sustained a 75% CRC screening rate in the 6-month post-project period.

Conclusions:

• A multidisciplinary team approach, leadership engagement, and staff involvement successfully increased and sustained CRC screening rates.
• Faecal immunochemical test (FIT) is a preferred screening method for average-risk patients.
• Sustainable annual FIT testing is essential for long-term CRC screening success.