Patient Navigation After Positive Fecal Immunochemical Test Results Increases Diagnostic Colonoscopy and Highlights Multilevel Barriers to Follow-Up

被引:14
作者
Cusumano, Vivy T. [1 ,2 ]
Myint, Anthony [1 ,2 ]
Corona, Edgar [1 ,2 ]
Yang, Liu [1 ,2 ]
Bocek, Jennifer [1 ,3 ,4 ]
Lopez, Antonio G. [1 ]
Huang, Marcela Zhou [1 ]
Raja, Naveen [1 ,3 ,4 ]
Dermenchyan, Anna [1 ,5 ]
Roh, Lily [1 ,3 ,4 ]
Han, Maria [1 ,5 ]
Croymans, Daniel [1 ,5 ]
May, Folasade P. [1 ,2 ,6 ,7 ]
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, Dept Med, 650 Charles Young Dr South,Room A2-125 CHS, Los Angeles, CA 90095 USA
[2] UCLA, David Geffen Sch Med, Vatche & Tamar Manoukian Div Digest Dis, Dept Med, Los Angeles, CA 90095 USA
[3] Univ Calif Los Angeles, Fac Practice Grp, Los Angeles, CA USA
[4] Univ Calif Los Angeles, Off Populat Hlth & Accountable Care, Los Angeles, CA USA
[5] Univ Calif Los Angeles, Dept Med, Qual Program, Los Angeles, CA 90024 USA
[6] Univ Calif Los Angeles, UCLA Kaiser Permanente Ctr Hlth Equ, Jonsson Comprehens Canc Ctr, Canc Prevent Control Res, Los Angeles, CA 90095 USA
[7] VA Greater Los Angeles Healthcare Syst, Div Gastroenterol, Dept Med, Los Angeles, CA 90073 USA
关键词
Colorectal cancer; Stool-based test; Cancer screening; Prevention; OCCULT BLOOD-TEST; COMMUNITY-HEALTH CENTER; CANCER SCREENING-TEST; COLORECTAL-CANCER; TASK-FORCE; PHYSICIANS; PROGRAM; IMPROVE; BREAST; TRIAL;
D O I
10.1007/s10620-021-06866-x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background The fecal immunochemical test (FIT) is a common colorectal cancer screening modality in the USA but often is not followed by diagnostic colonoscopy. Aims We investigated the efficacy of patient navigation to increase diagnostic colonoscopy after positive FIT results and determined persistent barriers to follow-up despite navigation in a large, academic healthcare system. Methods The study cohort included all health system outpatients with an assigned primary care provider, a positive FIT result between 12/01/2016 and 06/01/2019, and no documentation of colonoscopy after positive FIT. Two non-clinical patient navigators engaged patients and providers to encourage follow-up, offer solutions to barriers, and assist with colonoscopy scheduling. The primary intervention endpoint was completion of colonoscopy within 6 months of navigation. We documented reasons for persistent barriers to colonoscopy despite navigation and determined predictors of successful follow-up after navigation. Results There were 119 patients who received intervention. Of these, 37 (31.1%) patients completed colonoscopy at 6 months. In 41/119 (34.5%) cases, the PCP did not recommend colonoscopy, most commonly due to a normal colonoscopy prior to the positive FIT (19, 46.3%). There were 41/119 patients (34.5%) that declined colonoscopy despite the patient navigator and the PCP order. Male sex and younger age were significant predictors of follow-up (aOR = 2.91, 95%CI, 1.18-7.13; aOR = 0.92, 95%CI, 0.87-0.99). Conclusions After implementation of patient navigation, diagnostic colonoscopy was completed for 31.1% of patients with a positive FIT result. However, navigation also highlighted persistent multilevel barriers to follow-up. Future work will develop targeted solutions for these barriers to further increase FIT follow-up rates in our health system.
引用
收藏
页码:3760 / 3768
页数:9
相关论文
共 49 条
  • [1] Bakhai Smita, 2018, BMJ Open Qual, V7, pe000400, DOI 10.1136/bmjoq-2018-000400
  • [2] Association between time to colonoscopy after a positive guaiac fecal test result and risk of colorectal cancer and advanced stage disease at diagnosis
    Beshara, Amani
    Ahoroni, Maya
    Comanester, Doron
    Vilkin, Alex
    Boltin, Doron
    Dotan, Iris
    Niv, Yaron
    Cohen, Arnon D.
    Levi, Zohar
    [J]. INTERNATIONAL JOURNAL OF CANCER, 2020, 146 (06) : 1532 - 1540
  • [3] Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States
    Beydoun, Hind A.
    Beydoun, May A.
    [J]. CANCER CAUSES & CONTROL, 2008, 19 (04) : 339 - 359
  • [4] Screening for Colorectal Cancer US Preventive Services Task Force Recommendation Statement
    Bibbins-Domingo, Kirsten
    Grossman, David C.
    Curry, Susan J.
    Davidson, Karina W.
    Epling, John W., Jr.
    Garcia, Francisco A. R.
    Gillman, Matthew W.
    Harper, Diane M.
    Kemper, Alex R.
    Krist, Alex H.
    Kurth, Ann E.
    Landefeld, C. Seth
    Mangione, Carol M.
    Owens, Douglas K.
    Phillips, William R.
    Phipps, Maureen G.
    Pignone, Michael P.
    Siu, Albert L.
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2016, 315 (23): : 2564 - 2575
  • [5] The influence of waiting times on cost-effectiveness: a case study of colorectal cancer mass screening
    Chauvin, Pauline
    Josselin, Jean-Michel
    Heresbach, Denis
    [J]. EUROPEAN JOURNAL OF HEALTH ECONOMICS, 2014, 15 (08) : 801 - 812
  • [6] A program to enhance completion of screening colonoscopy among urban minorities
    Chew, Lea Ann
    Santos, Stephanie
    Jandorf, Lina
    Christie, Jennifer
    Castillo, Anabella
    Winke, Gary
    Itzkowitz, Steven
    [J]. CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, 2008, 6 (04) : 443 - 450
  • [7] A randomized controlled trial using patient navigation to increase colonoscopy screening among low-income minorities
    Christie, Jennifer
    Itzkowitz, Steven
    Lihau-Nkanza, Irene
    Castillo, Anabella
    Redd, William
    Jandorf, Lina
    [J]. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, 2008, 100 (03) : 278 - 284
  • [8] Time to Colonoscopy after Positive Fecal Blood Test in Four US Health Care Systems
    Chubak, Jessica
    Garcia, Michael P.
    Burnett-Hartman, Andrea N.
    Zheng, Yingye
    Corley, Douglas A.
    Halm, Ethan A.
    Singal, Amit G.
    Klabunde, Carrie N.
    Doubeni, Chyke A.
    Kamineni, Aruna
    Levin, Theodore R.
    Schottinger, Joanne E.
    Green, Beverly B.
    Quinn, Virginia P.
    Rutter, Carolyn M.
    [J]. CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION, 2016, 25 (02) : 344 - 350
  • [9] Addressing Social Determinants of Health to Improve Access to Early Breast Cancer Detection: Results of the Boston REACH 2010 Breast and Cervical Cancer Coalition Women's Health Demonstration Project
    Clark, Cheryl R.
    Baril, Nashira
    Kunicki, Marycarmen
    Johnson, Natacha
    Soukup, Jane
    Ferguson, Kathleen
    Lipsitz, Stuart
    Bigby, JudyAnn
    [J]. JOURNAL OF WOMENS HEALTH, 2009, 18 (05) : 677 - 690
  • [10] Association Between Time to Colonoscopy After a Positive Fecal Test Result and Risk of Colorectal Cancer and Cancer Stage at Diagnosis
    Corley, Douglas A.
    Jensen, Christopher D.
    Quinn, Virginia P.
    Doubeni, Chyke A.
    Zauber, Ann G.
    Lee, Jeffrey K.
    Schottinger, Joanne E.
    Marks, Amy R.
    Zhao, Wei K.
    Ghai, Nirupa R.
    Lee, Alexander T.
    Contreras, Richard
    Quesenberry, Charles P.
    Fireman, Bruce H.
    Levin, Theodore R.
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2017, 317 (16): : 1631 - 1641