P3207 - Ambulatory Safety Net Improves Colorectal Cancer Recall Following a Positive Non-invasive Colon Cancer Screening Test

Joseph D. Feuerstein, MD¹, Matthew Germak, MD, MPH², Jason Nigrosh, ², Katherine Brunner, MD³, Lawrence Borges, MD⁴, Jonathan Li, MD¹, Andrew Popelka, MD, MBA⁵, Spencer Rittner, MD⁶, Katherine Urbaez, ⁷, Heidi Sheehan, MS, MA, CPHQ⁸, Barbara Savage, BA, MBA⁹, Robert Fields, MD, MHA^9
1Beth Israel Deaconess Medical Center, Boston, MA; ²BILH, Needham, MA; ³Lahey Medical Center, Burlington, MA; ⁴Mount Auburn Hospital, Cambridge, MA; ⁵Lahey Clinic - BILH, Burlington, MA; ⁶BILH, Boston, MA; ⁷Beth Israel Lahey Health, Boston, MA; ⁸Beth Israel Lahey Health Performance Network, Arlington, MA; ⁹BILH, Cambridge, MA

Introduction: With the increasing use of non-invasive colorectal cancer (CRC) screening tests, it is of increasing importance to institute a recall system to identify patients with positive results who are due for urgent colonoscopy. Our study is the summary of the implementation of an ambulatory safety net (ASN) in a large healthcare system to identify patients with positive non-invasive tests that did not undergo colonoscopy within 3 months of the result.

Methods: Funded from a CRICO grant, Beth Israel Lahey Health developed a system wide ASN. To start the ASN, records from August 2021- February 2023 at two hospital sites were reviewed to identify patients who underwent a non-invasive CRC test and did not have a colonoscopy within 3 months of the positive results. A patient navigator attempted to outreach to patients via phone, patient portal, text messaging and/or letters mailed to patients. A Patient Navigator’s objective was to facilitate the scheduling of a diagnostic colonoscopy.

Results: 198 patients were identified as potentially having a delay in colonoscopy scheduling following positive non-invasive CRC test. Of the 198, 54% of patients were not followed up by the navigator for the following reasons: had a procedure scheduled (n=32), completed colonoscopy (n=33), no longer clinically indicated (n=38) and 4 were excluded from the ASN for other reasons. The remaining 91 (46%) patients were contacted via multiple modalities with phone and portal messages being the most common. Of the 91 patients, the navigator facilitated scheduling overdue colonoscopies for 19 patients (21%). Successful outreach was achieved on the first phone call, portal message or text message in all but 1 case that required a second call. On average, it took the navigator 13.5 mins to review a chart for eligibility in the ASN. First phone calls took an average of 6 mins while text messages took an average of 15 mins/patient associated with the back-and-forth messaging to patients. In 4 patients monitored in a time-study, scheduling a colonoscopy took an avg of 47.5 min/patient to schedule their procedure. See table 1 for details.

Discussion: The current local recall systems in place failed to identify all patients in need of urgent colonoscopy following a positive non-invasive CRC test. Setting up a system-level ASN is critical to the safety of a non-invasive CRC screening program as it facilitates loop closure and potentially can mitigate delayed or missed diagnoses of CRC.


Disclosures:


Joseph D. Feuerstein, MD¹, Matthew Germak, MD, MPH², Jason Nigrosh, ², Katherine Brunner, MD³, Lawrence Borges, MD⁴, Jonathan Li, MD¹, Andrew Popelka, MD, MBA⁵, Spencer Rittner, MD⁶, Katherine Urbaez, ⁷, Heidi Sheehan, MS, MA, CPHQ⁸, Barbara Savage, BA, MBA⁹, Robert Fields, MD, MHA⁹. P3207 - Ambulatory Safety Net Improves Colorectal Cancer Recall Following a Positive Non-invasive Colon Cancer Screening Test, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.