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    Implementing ambulatory safety nets (ASNs) for colorectal cancer (CRC) screening successfully identified patients needing follow-up and improved colonoscopy completion rates, reducing diagnostic delays.

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    Area of Science:

    • Healthcare Quality Improvement
    • Patient Safety
    • Colorectal Cancer Screening

    Background:

    • Millions of adults face delayed diagnoses annually due to diagnostic errors.
    • Ambulatory safety nets (ASNs) are interventions designed to mitigate delayed diagnoses by tracking patients with abnormal results needing follow-up.
    • Colorectal cancer (CRC) screening presents a critical area for ASN implementation to prevent diagnostic delays.

    Purpose of the Study:

    • To co-design a collaborative model for implementing ambulatory safety nets (ASNs) focused on colorectal cancer (CRC).
    • To develop guidance and measures for establishing and sustaining CRC ASNs across diverse healthcare settings.
    • To evaluate the effectiveness of collaborative CRC ASNs in facilitating patient follow-up after abnormal screening.

    Main Methods:

    • A working group co-designed implementation guidance, measures, and a collaborative model.
    • Six healthcare sites participated in an 18-month Breakthrough Series Collaborative, focusing on ASNs for positive at-home CRC screening or overdue surveillance colonoscopies.
    • Monthly data collection tracked patient contact, scheduling, and completion of follow-up colonoscopies within the ASNs.

    Main Results:

    • Four of six participating sites had operational ASNs by the end of the collaborative, with the remaining two launching shortly after.
    • Collaborative ASNs identified 5,165 patients needing outreach for follow-up care between October 2022 and February 2024.
    • Among patients identified, 68.8% were successfully contacted, 39.9% were scheduled for a colonoscopy, and 29.1% completed the procedure.

    Conclusions:

    • The collaborative approach successfully identified patients with abnormal CRC screening results and facilitated completion of necessary follow-up colonoscopies.
    • The developed CRC ASN Implementation Guide provides a roadmap for healthcare leaders aiming to establish similar safety nets.
    • Implementation of ASNs is a viable strategy to improve patient follow-up and reduce diagnostic delays in colorectal cancer care.