Increasing Fecal Immunochemical Testing in a Community Health Clinic

Abstract

Problem and Purpose: In 2022, data collected from the electronic health records at a community health center showed that only 24.87% (n=226) out of 908 patients were considered current for colorectal cancer screening. Of those patients who were current, 177 fecal immunochemical test (FIT) kits were ordered by staff, and 35% completed. Several causes of failure to screen include inadequate follow-up after FIT orders, failure to utilize lab tracking reports to monitor pending labs due to staff shortages, and non-adherence to clinic procedures for distributing FIT kits to patients. The purpose of this quality improvement project was to implement and evaluate the effectiveness of a multi-component process for improving colorectal screening by increasing FIT screening by 25% through increased utilization of FIT testing. Methods: The initiative occurred between September through December 2023. Metrics measured the overall percentage of FIT ordered; reminder calls made, FIT completed and result follow-up. The process included maintaining an adequate supply of FIT kits and the generation of a report listing the patients eligible for Colorectal Cancer Screening (CRCS) each clinic day, which also prompted mailing of FIT kits to patients seen virtually who opted for FIT. A reminder telephone call was made to patients who had not returned the completed test after one week. Results and Conclusion: During the fourteen weeks FIT was ordered for 117 eligible patients with a 54% completion rate (n=63). Staff followed up results with 100% of eligible patients (n=63). Reminder phone calls were attempted for 79% of patients that had not returned FIT after 1 week (n=93) and completed for 52% of the patients (n=61). Data suggests that a multicomponent process including distribution of FIT kits, reminder phone calls and provider followup may increase FIT screening and patient participation in colorectal cancer screening. Keywords: FIT, phone reminders, occult blood, stool testing, colorectal cancer screening