Time to Follow-Up Colonoscopy After Positive Fecal Immunochemical Test with Centralized Patient Navigation: A...

Area of Science:

• Public Health
• Health Services Research
• Gastroenterology

Background:

• Federally qualified health centers (FQHCs) face challenges with timely follow-up colonoscopy (FC) completion after positive fecal immunochemical tests (FIT).
• Delays in FC are linked to increased colorectal cancer (CRC) incidence, late-stage diagnoses, and mortality.

Purpose of the Study:

• To assess the effectiveness of centralized patient navigation in improving FC completion rates.
• To evaluate the impact of patient navigation on reducing the time to FC following a positive FIT.

Main Methods:

• A sub-analysis of a randomized clinical trial involving patients with positive FIT results in FQHC systems.
• Comparison of outcomes between patients receiving centralized telephone-based navigation and those receiving usual care over one year.
• Survival analysis was used to compare the restricted mean time to FC.

Main Results:

• Centralized patient navigation led to significantly higher FC completion rates (69.0% vs. 38.7%, p=0.006) compared to usual care.
• The mean time to FC was reduced by 80.4 days (p=0.018) in the navigation group.
• Increased engagement with navigation further enhanced the reduction in time to FC.

Conclusions:

• Centralized patient navigation is a highly effective intervention for increasing FC completion and reducing diagnostic delays after positive FIT results in FQHC settings.
• Patient navigation plays a crucial role in ensuring timely diagnostic resolution for positive CRC screening in underserved populations.