C0165 - Following Through on Positive Fecal Immunochemical Testing via FIT Navigation and a Direct-to-Colonoscopy Pathway: Preparing for the Next Wave

Judah Kreinbrook, BS¹, Sonya Bhaskar, MD², Azubuogu Anudu, MD², Wesley Wright, MD², Samuel Slone, MD², Sabrina Prabakaran, MD², Saritza Mendoza, MD, MHS³, Abid Javed, MD³, Phillip Foulis, MD, MPH⁴, Jason M. Colizzo, MD⁴, Wojciech Blonski, MD, PhD⁴, Kaileen Legard, MSN, ARNP⁴, Jose Lezama, MD^4
1Tampa VA Clinical Research and Education Center, Tampa, FL; ²University of South Florida Morsani College of Medicine, Tampa, FL; ³University of South Florida, Tampa, FL; ⁴James A. Haley VA Hospital, Tampa, FL

Introduction: Colorectal cancer screening was disrupted during the COVID-19 pandemic, resulting in some systems utilizing mail-out fecal immunochemical testing (FIT) in average-risk patients. Our facility initiated this in late March 2020; adding a FIT navigator position in August. FIT navigation (FITNav) has shown success in clinical trials; however, formal guidance on its implementation is scarce. After noting no improvement in an administrative metric measuring colonoscopy < 180 days after +FIT, we initiated a multi-stage QI project which began with stakeholder meetings and retrospective chart review.

Methods: After process mapping, we queried all index +FIT from Mar. 1, 2019 - Sept. 3, 2021. Manual chart review abstracted order notes, gastroenterology consults, and records of patient/navigator notification. +FIT were divided into three periods: Mar. 1 - Sept. 3 2019, 2020, 2021: pre-pandemic, early pandemic, and late pandemic. FITNav was fully implemented in the latter. Dementia & >65 y/o, diagnostic FIT, inpatient FIT, or comorbidities judged by a GI clinician to increase anesthesia risk were exclusion criteria. The unadjusted and adjusted association between late & early pandemic proportion receiving colonoscopy < 180 days was assessed using binary logistic regression, summarized as odds ratio (OR) and 95% confidence intervals (CI).

Results: 121, 103, and 253 index +FIT met criteria over the pre, early, and late pandemic. While no significant differences in demographics were present, days to patient notification rose from mean (SD) of 7.8 (6.1) to 10.4 (17.3) in early pandemic, returning to 7.2 (8.2) in late pandemic (p=0.01). Proportion receiving colonoscopy < 180 days was 53.7%, 60.2%, and 58.5% (Unadjusted OR 1.08; 95% CI .60-1.94 p=0.796). Adjusted OR was similar (0.94; 95% CI 0.58-1.52, p=0.787). 20.2% of late pandemic +FIT were not sent to FITNav.

Discussion: This analysis suggests that in the early pandemic, colonoscopy < 180 days was maintained. This data also suggests that FITNav implementation without further system design was insufficient to increase colonoscopy < 180 days. These findings prompted creation of a direct-to-colonoscopy pathway and a centralized Microsoft Access database which went live May 27, 2022. This intervention gives the FITNav access to all +FIT on the day of results, semi-automated alerts, and prospective data collection for future improvement cycles. Systems considering FITNav should understand that implementation may require such efforts to achieve success.



Disclosures:


Judah Kreinbrook, BS¹, Sonya Bhaskar, MD², Azubuogu Anudu, MD², Wesley Wright, MD², Samuel Slone, MD², Sabrina Prabakaran, MD², Saritza Mendoza, MD, MHS³, Abid Javed, MD³, Phillip Foulis, MD, MPH⁴, Jason M. Colizzo, MD⁴, Wojciech Blonski, MD, PhD⁴, Kaileen Legard, MSN, ARNP⁴, Jose Lezama, MD⁴. C0165 - Following Through on Positive Fecal Immunochemical Testing via FIT Navigation and a Direct-to-Colonoscopy Pathway: Preparing for the Next Wave, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.