P3209 - Impact of Patient Navigator to Improve Completion of Fecal Immunochemical Testing in Primary Care: Patient’s Profile Perspective

Hannah W. Fiske, MD¹, J Filipe Monteiro, PhD², Ross Hilliard, MD³, Ricky D. Grisson, MD, MBA, MPH⁴, Marlaydis Holloway, BS⁵, Carrie Bridges Feliz, MPH⁶, Ana Almeida DoRosario, BA⁶, Harlan Rich, MD^3
1Brown University/Rhode Island Hospital, Providence, RI; ²Brown Medicine/Lifespan, Providence, RI; ³Warren Alpert Medical School of Brown University, Providence, RI; ⁴Lifespan Academic Medical Centers, Providence, RI; ⁵Lifespan, Providence, RI; ⁶Lifespan Community Health Institute, Providence, RI

Introduction: Colorectal cancer (CRC) screening is a critical preventative health service, yet a third of the eligible US population fails to undergo routine screening. The ACG 2021 Clinical Guidelines suggest utilizing patient navigators to improve adherence. This study investigates the impact of patient navigation on fecal immunochemical testing (FIT) kit return rates, by demographics, exploring which groups were most impacted by the addition of a navigator.

Methods: We conducted a retrospective analysis investigating the impact of a patient navigator on successful return of FIT kits for 3542 unique patients. FIT kits were ordered and analyzed from 01/2017 – 12/2021; in 01/2021 we introduced a dedicated patient navigator to support patients in completing FIT. Chi-square, Fisher exact, and Student’s t-tests were performed for descriptive analyses. Multivariable Cox Hazard regression model was used to compare FIT kit drop off rates pre- and post-intervention; analysis was performed in SAS version 9.4. When applicable, models were adjusted by gender, age, ethnicity, race, language, area deprivation index (ADI), and medically underserved areas.

Results: Overall, the intervention improved completion rates from 67% to 80% with a hazard ratio (HR) of 1.39 and 95% confidence interval (CI) [1.260; 1.522]. Our patient population was quite diverse (Table 1). An analysis of return rates by demographics (Figure 1) highlights how specific populations were impacted by the addition of the navigator, compared with an overall improvement of 1.39. Enhanced FIT kit return was seen in females (1.46[1.27;1.68]), younger patients aged 45-50 (1.53[1.12;2.08]) and 51-64 (1.42[1.26;1.61]), non-Hispanic (1.46[1.28;1.67]) white (1.50[1.25;1.80]) and black (1.48[1.22;1.79]) patients, those on Medicaid (1.45[1.26;1.69]) or Commercial (1.48[1.22;1.79]) insurance, English-speakers (1.52[1.32;1.74]), and patients from neighborhoods with ADI scores of 5-6 (1.47[1.123,1.923]) and 7-8 (1.42[1.019-1.966]).

Discussion: In this retrospective analysis, certain populations more significantly responded to our intervention. Screening rates for CRC are negatively impacted by the presence of healthcare disparities. The addition of a dedicated patient navigator helps improve compliance with CRC screening, but it is crucial for healthcare systems to develop methods to better understand those populations which did not respond as well to the navigator and cultivate even more effective targeted support strategies.



Disclosures:


Hannah W. Fiske, MD¹, J Filipe Monteiro, PhD², Ross Hilliard, MD³, Ricky D. Grisson, MD, MBA, MPH⁴, Marlaydis Holloway, BS⁵, Carrie Bridges Feliz, MPH⁶, Ana Almeida DoRosario, BA⁶, Harlan Rich, MD³. P3209 - Impact of Patient Navigator to Improve Completion of Fecal Immunochemical Testing in Primary Care: Patient’s Profile Perspective, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.