Standardized Workflows Improve Colonoscopy Follow-Up After Abnormal Fecal Immunochemical Tests in a Safety-Net System

• Published in: Digestive diseases and sciences 2021-03, Vol.66 (3), p.768-774
• Main Authors: Issaka, Rachel B., Rachocki, Carly, Huynh, Michael P., Chen, Ellen, Somsouk, Ma
• Format: Article
• Language: English
• Subjects: Aftercare - standards; Aged; Biochemistry; Clinics; Colonoscopy; Colonoscopy - standards; Colorectal cancer; Colorectal Neoplasms - diagnosis; Cross-Sectional Studies; Early Detection of Cancer - methods; Early Detection of Cancer - standards; Electronic health records; Feces; Female; Gastroenterology; Health care networks; Health care policy; Hepatology; Humans; Laboratories; Male; Medical colleges; Medical diagnosis; Medical records; Medical referrals; Medical research; Medicine; Medicine & Public Health; Middle Aged; Occult Blood; Oncology; Original Article; Patients; Polls & surveys; Population; Practice Patterns, Physicians' - standards; Primary care; Primary Health Care - standards; Public health; Questionnaires; Safety and security measures; Safety-net Providers - standards; Surveys and Questionnaires; Transplant Surgery; Workflow
• ISSN: 0163-2116; 1573-2568
• DOI: 10.1007/s10620-020-06228-z

Background How clinical teams function varies across sites and may affect follow-up of abnormal fecal immunochemical test (FIT) results. Aims This study aimed to identify the characteristics of clinical practices associated with higher diagnostic colonoscopy completion after an abnormal FIT result in a multi-site integrated safety-net system. Methods We distributed survey questionnaires about tracking and follow-up of abnormal FIT results to primary care team members across 11 safety-net clinics from January 2017 to April 2017. Surveys were distributed at all-staff clinic meetings and electronic surveys sent to those not in attendance. Participants received up to three reminders to complete the survey. Results Of the 501 primary care team members identified, 343 (68.5%) completed the survey. In the four highest-performing clinics, nurse managers identified at least two team members who were responsible for communicating abnormal FIT results to patients. Additionally, team members used a clinic-based registry to track patients with abnormal FIT results until colonoscopy completion. Compared to higher-performing clinics, lower-performing clinics more frequently cited competing health issues (56% vs. 40%, p  = 0.03) and lack of patient priority (59% vs. 37%, p