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Systems-based Strategies Improve Positive Screening Fecal Immunochemical Testing Follow-up and Reduce Time to

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Implementing process improvements for fecal immunochemical testing (FIT) significantly increased timely colonoscopy follow-up for colorectal cancer (CRC) screening. This initiative enhanced patient safety and quality of care within the military health system.

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Area of Science:

  • Gastroenterology
  • Public Health
  • Health Services Research

Background:

  • Fecal immunochemical testing (FIT) is a primary colorectal cancer (CRC) screening method globally, yet patient follow-up after positive results can be suboptimal.
  • Vulnerabilities in care pathways for patients undergoing CRC screening within the military health system necessitate improved practices.
  • Previous reports indicated poor organizational performance in managing positive FIT results.

Purpose of the Study:

  • To evaluate the impact of a process improvement initiative on colonoscopy completion rates and timeliness after positive FIT results.
  • To enhance the safety and quality of care for patients requiring follow-up diagnostic procedures post-FIT screening.
  • To address identified care gaps in the CRC screening pathway within a military healthcare setting.

Main Methods:

  • A multi-faceted process improvement initiative was implemented, including mandatory indication labeling for FIT orders and the use of nurse navigators for expedited follow-up.
  • The study compared colonoscopy completion rates and time-to-colonoscopy before (control period) and after the intervention.
  • Data analysis focused on assessing the effectiveness of standardized ordering and proactive patient navigation.

Main Results:

  • Before the intervention, only 34.8% of patients had appropriate follow-up for positive FIT, with an average wait time of 140.1 days.
  • Post-intervention, the colonoscopy follow-up rate dramatically increased to 91.9%, with the average interval reduced to 21.9 days.
  • The initiative resulted in a 57.1% absolute increase in timely diagnostic colonoscopies following positive FIT results.

Conclusions:

  • Process improvements, specifically mandatory indication labeling and patient navigation, significantly improve timely diagnostic colonoscopy rates after positive FIT screening.
  • These systems-based solutions are crucial for enhancing CRC screening effectiveness and patient outcomes.
  • Adoption of similar reliable systems should be considered for other preventative screening interventions.