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Showing content from https://pubmed.ncbi.nlm.nih.gov/32236885/ below:

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

. 2021 Mar;66(3):768-774. doi: 10.1007/s10620-020-06228-z. Epub 2020 Mar 31. Standardized Workflows Improve Colonoscopy Follow-Up After Abnormal Fecal Immunochemical Tests in a Safety-Net System

Affiliations

¹ Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA. rissaka@fredhutch.org.
² Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. rissaka@fredhutch.org.
³ Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA. rissaka@fredhutch.org.
⁴ Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA.
⁵ School of Public Health, UCLA Center for Health Policy Research, Los Angeles, CA, USA.
⁶ San Francisco Department of Public Health, San Francisco, CA, USA.
⁷ Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, USA.

PMID: 32236885
PMCID: PMC7529734
DOI: 10.1007/s10620-020-06228-z

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

Rachel B Issaka et al. Dig Dis Sci. 2021 Mar.

. 2021 Mar;66(3):768-774. doi: 10.1007/s10620-020-06228-z. Epub 2020 Mar 31. Affiliations

¹ Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M/S: M3-B232, Seattle, WA, 98109, USA. rissaka@fredhutch.org.
² Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. rissaka@fredhutch.org.
³ Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA. rissaka@fredhutch.org.
⁴ Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, USA.
⁵ School of Public Health, UCLA Center for Health Policy Research, Los Angeles, CA, USA.
⁶ San Francisco Department of Public Health, San Francisco, CA, USA.
⁷ Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, USA.

PMID: 32236885
PMCID: PMC7529734
DOI: 10.1007/s10620-020-06228-z

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Abstract

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 < 0.01) as barriers and were also more likely to discuss abnormal results at a clinic visit (83% vs. 61%, p < 0.01).

Conclusions: Our findings suggest organized and dedicated efforts to communicate abnormal FIT results and track patients until colonoscopy completion through registries is associated with improved follow-up. Increased utilization of electronic health record platforms to coordinate communication and navigation may improve diagnostic colonoscopy rates in patients with abnormal FIT results.

Keywords: Colorectal cancer; Diagnostic colonoscopy; Electronic health records; Fecal immunochemical test; Standardized workflows.

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Conflict of interest statement

Conflict of Interest Disclosure Statement : The authors declare no potential conflicts of interest.

Figures
Figure 1:

Recommended process map for abnormal…

Figure 1:

Recommended process map for abnormal FIT follow-up MEA: Medication Evaluation Assistant; RN: Registered…

Figure 1:

Recommended process map for abnormal FIT follow-up MEA: Medication Evaluation Assistant; RN: Registered Nurse; PCP: Primary Care Physician; GI: Gastroenterologist; FIT: Fecal Immunochemical Test