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Multicenter Study
. 2019 Dec 1;125(23):4203-4209.
doi: 10.1002/cncr.32440. Epub 2019 Sep 3.

Diagnostic colonoscopy completion after abnormal fecal immunochemical testing and quality of tests used at 8 Federally Qualified Health Centers in Southern California: Opportunities for improving screening outcomes

Balambal Bharti  1   2 , Folasade Fola Popoola May  3   4 , Jesse Nodora  1   2   5 , María Elena Martínez  1   2   5 , Karina Moyano  6 , Shauntay L Davis  7 , Christian B Ramers  1   8 , Felipe Garcia-Bigley  8 , Shawne O'Connell  9 , Kevin Ronan  10 , Melissa Barajas  11 , Sheree Gordon  12 , Giselle Diaz  13 , Evelyn Ceja  14 , Meghan Powers  15 , Elva M Arredondo  16 , Samir Gupta  1   2   17
Affiliations
Multicenter Study

Diagnostic colonoscopy completion after abnormal fecal immunochemical testing and quality of tests used at 8 Federally Qualified Health Centers in Southern California: Opportunities for improving screening outcomes

Balambal Bharti et al. Cancer. .

Abstract

Background: The effectiveness of colorectal cancer screening with fecal immunochemical tests (FITs) of stool blood depends on high rates of colonoscopy follow-up for abnormal FITs and the use of high-quality tests. This study characterized colonoscopy referral and completion among patients with abnormal FITs and the types of FITs implemented in a sample of Southern California Federally Qualified Health Centers (FQHCs).

Methods: FQHCs in San Diego, Imperial, and Los Angeles Counties were invited to define a cohort of ≥150 consecutive patients with abnormal FITs in 2015-2016 and to provide data on sex, insurance status, diagnostic colonoscopy referrals and completion within 6 months of abnormal FITs, and the types (brands) of FITs implemented. The primary outcomes were the proportions with colonoscopy referrals and completion for all patients at each FQHC and in aggregate.

Results: Eight FQHCs provided data for 1229 patients with abnormal FITs; 46% were male, and 20% were uninsured. Among patients with abnormal FITs, 89% (1091 of 1229; 95% confidence interval [CI], 0.87-0.91) had a colonoscopy referral, and 44% (539 of 1229; 95% CI, 0.41-0.47) had colonoscopy completion. Across FQHCs, the range for colonoscopy referral was 73% to 96%, and the range for completion was 18% to 57%. Six of the 8 FQHCs (75%) reported FIT brands with limited data to support their effectiveness.

Conclusions: In a sample of Southern California FQHCs, diagnostic colonoscopy completion after abnormal FITs was substantially below the nationally recommended benchmark to achieve 80% completion, and the use of FIT brands with limited data to support their effectiveness was high. These findings suggest a need for policies and multilevel interventions to promote diagnostic colonoscopy among individuals with abnormal FITs and the use of higher quality FITs.

Keywords: Federally Qualified Health Center; Hispanic; abnormal fecal immunochemical test (FIT); colorectal cancer; screening.

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Conflict of interest statement

Conflict of Interest Statement

The Authors have no relevant conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:. Study flow and overall summary of colonoscopy referral and completion in a sample of Federally Qualified Health Centers in San Diego, Imperial and Los Angeles Counties of California; Jan 2015-June 2016; N= 1229.
The process for sample selection, and overall summary rate of colonoscopy referral and completion at included Federally Qualified Health Centers is depicted.
Figure 2:
Figure 2:. Diagnostic colonoscopy referral and completion rates after abnormal FIT across a sample of 8 Federally Qualified Health Centers in San Diego, Imperial and Los Angeles Counties of California; Jan 2015-June 2016; N= 1229.
Proportion of patients with abnormal FIT with colonoscopy referral and colonoscopy completion are depicted for each included FQHC. FIT, fecal immunochemical test; FQHC, Federally Qualified Health Center.
See this image and copyright information in PMC

Comment in

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