There is not a clearly defined process for follow-up in patients with a positive FIT ordered by primary care. Among patients with an abnormal FIT result, between 1 in 10 and 1 in 30 have colorectal cancer (CRC), and failure to complete a colonoscopy is associated with a higher risk of colorectal cancer death.
Successful applicants to the ASGE Endoscopy Unit Recognition Program (EURP) submit a summary of a recently conducted quality improvement (QI) project as part of the application process. The QI project in the spotlight this month looked at tracking abnormal fecal immunochemical tests (FITs).
DEFINE
Focus: There is not a clearly defined process for follow-up in patients with a positive FIT ordered by primary care. Among patients with an abnormal FIT result, between 1 in 10 and 1 in 30 have colorectal cancer (CRC), and failure to complete a colonoscopy is associated with a higher risk of colorectal cancer death.1-3
Scope of Project: Follow-up of patient, starting at the time of abnormal FIT results to completion of colonoscopy. An interdisciplinary team was created, comprised of primary care, population health and gastroenterology.
Project Goals: Create transparent process for follow up of abnormal FIT. Create a way to track data on abnormal FIT, and use Plan-Do-Study-Act (PDSA) model to determine whether intervention was successful in completion of colonoscopy for patients.
MEASURE
- Number of patients that had FIT tests that had a colonoscopy following the positive FIT test
- Data acquired through EPIC, identified patients with a positive FIT test and whether or not they had a colonoscopy
- Baseline: 65 patients over last year with abnormal FIT did not have outreach or complete a colonoscopy
- Target: 100 percent of patients who did not schedule/undergo a colonoscopy after a positive FIT to have live outreach and follow-up letters
ANALYZE
Quality improvement tools:
- Report in EPIC created by IS team
- Standard work, show steps in process and team member responsible for tasks
- Standardized letter with evidence-based language reviewed by physician expert was created
- Tracking system in Excel created to collect data on patients who received outreach, type of outreach and results of outreach
- Process map for CRC screening; FIT embedded in map as part of the test
IMPROVE
Implemented the standard work and data collection. Repeat measurement of performance showed:
- 100 percent of patients received standardized outreach with abnormal FIT
- 21/65 patients completed colonoscopy
- New patients with abnormal results
CONTROL
Summary: Achieved the project goal of implementing standard work and increasing live outreach to patients with a positive FIT. One of the barriers to the project is the age of patients in the FIT report, set at aged 50 years to align with the screening colonoscopy guideline, but this is not relevant to FIT. Patients of any age with a positive FIT need a colonoscopy. The improvements made are sustainable. PDSA is needed. The project is in the early stages. Improvements in automated data collection, outreach and reporting are needed.
We hope sharing this project summary will be useful to you and your practice. Learn more about gaining honoree status in the ASGE Endoscopy Unit Recognition Program. EURP honoree units may use the ASGE Quality Star logo in promotion of their units, receive premium educational content bimonthly via an exclusive e-newsletter The Huddle and enjoy a range of additional benefits. Questions should be directed to eurp@asge.org.
References
- Gupta S, Nodora J. Optimizing the quality of the colorectal cancer screening continuum: a call to action. J Natl Cancer Inst. 2017;109:djw271
- Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370:1287-1297
- Lee YC, Li-Sheng Chen S, Ming-Fang Yen A, et al. Association between colorectal cancer mortality and gradient fecal hemoglobin concentration in colonoscopy noncompliers. J Natl Cancer Inst. 2017;109:djw269