Colorectal cancer (CRC) is a leading cause for cancer-related mortality in the United States (US), but
screening is underutilized, especially in low-resource settings and among low income populations. Federally
Qualified Health Centers (FQHC) are government-funded facilities that provide access to healthcare for
millions of low-income Americans each year and frequently use low-cost, non-invasive CRC screening
modalities like the fecal immunochemical test (FIT) to maximize screening participation. A major challenge for
FIT-based screening programs, however, is that positive FIT results are common (5-14%) and warrant
subsequent follow-up with diagnostic colonoscopy to assess for precancerous or cancerous lesions and avoid
poor CRC outcomes. In FQHCs, only 40% to 58% of patients complete colonoscopic follow-up after positive
FIT, which reflects a lack of clinical resources and optimal system processes to facilitate access to and patient
utilization of diagnostic colonoscopy.
The Northeast Valley Health Corporation (NEVHC) is one of the largest FQHCs in the nation and is
comprised of 14 integrated community-based facilities that serve primarily low-income and uninsured racial
and ethnic minorities. The proposed study aims to extend an existing partnership between the University of
California Los Angeles (UCLA) Center for Cancer Prevention and Control Research (CPCR) and NEVHC to
identify deficiencies in clinical care processes required to achieve colonoscopic follow-up after positive FIT.
The specific aims of the study are: 1) to use electronic medical record data to perform an in-depth evaluation of
the clinical processes between the identification of a positive FIT and completion of colonoscopy at NEVHC
and to determine the rate of completion and time to completion for each step in the clinical pathway (e.g.
patient notification of positive FIT result, colonoscopy referral); and 2) to conduct structured interviews with
NEVHC patients and providers and gastroenterologists to understand their perspectives on barriers and
facilitators to the clinical processes following a positive FIT. The proposed study fills an important gap in our
understanding of the system-level processes that may facilitate or impede completion of diagnostic follow-up
after a positive FIT result. Improving follow-up of abnormal CRC screening is highly responsive to the National
Cancer Institute Cancer Moonshot goals, the 80% by 2018 CRC screening campaign, and other national calls
to action regarding CRC screening. The information gained from our project will serve as the foundation for the
development of interventions to improve rates of colonoscopic follow-up after positive FIT for at-risk, low
income and minority patients in low resource settings.
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