P4788 - The Impact of a Patient Navigation System on Colonoscopy Completion Rates

Joshua Freeman, DO¹, Miranda Hart, MD²
1Swedish Covenant Hospital, Chicago, IL; 2Erie Family Health Centers, Chicago, IL

Introduction: Colorectal cancer (CRC) is a significant public health concern. It is the third leading cause of cancer death in men and the fourth leading cause in women. Despite the high sensitivity and ease of screening with Fecal immunochemical testing (FIT) and multitarget DNA tests (FIT-DNA i.e. Cologuard), adherence to follow up colonoscopies remains a challenge. National rates of follow up colonoscopy within 180 days after positive test are around 51%. Following up is an especially difficult task in a federally qualified health clinic (FQHC), where most patients (~90%) are low income and ~20% are uninsured. This study looks at the impact of implementing a patient navigation team at a FQHC.

Methods: This was a retrospective analysis looking at screening Cologuard tests and colonoscopy completion rates from 1/1/2023-8/31/2024. The main outcomes measured were colonoscopy rates and time to colonoscopy. There was a patient navigation system implemented on 8/2023. Additionally, there was a prior study at the same clinic from 12/2020-12/2021. Colonoscopy rates were compared using Chi-squared test and for the time to colonoscopy, a two sample t-test was used for analysis.

Results: In the post-navigator cohort, we see an increase in colonoscopy completion rate from 42.0% to 62.9% when compared to the pre-navigation cohort (p 0.0009). We see an increase from 13.7% to 62.9% when compared to the 2020 cohort (p< .0001). These are both statistically significant. In the post-navigator cohort the average amount of days to colonoscopy is 97.29 days, compared to 124 in the 2020 cohort (p< .0001), compared to 107 for the 2020 cohort (p=0.4237).

Discussion: After having a dedicated navigator committee, colonoscopy completion rates increased to higher than the national average. It consists of a dedicated staff who does an internal review of all positive Cologuard/FIT tests and subsequent referrals. They perform patient outreach by calling the patient monthly until they get through. They reach out to partnering hospitals to facilitate the scheduling process. They identify and address barriers to care for the patients. This has led to a statistically significant increase in colonoscopy completion rates and a statistically insignificant decrease in the time until colonoscopy. Being a retrospective study, there are limitations, it was a single center study with a small sample size. The original data was obtained in 2020, around the height of the COVID-19 pandemic.

Figure: Table A. Colonoscopy completion rates after positive Cologuard test comparing post-navigator cohort and 2020 cohort (p < 0.0001)

Table B. Colonoscopy completion rates after positive Cologuard test comparing post-navigator cohort and 2023 (pre-naviagtor) cohort (p=0.0009)

Table C. Days to Colonoscopy following positive Cologuard test comparing Post-navigator cohort and 2020 cohort (p < 0.0001)

Table D. Days to Colonoscopy following positive Cologuard test comparing Post-Navigator cohort and 2023 (pre-navigator) cohort (p=0.4237)



Figure: Table A. Colonoscopy completion rates after positive Cologuard test comparing post-navigator cohort and 2020 cohort (p < 0.0001)

Table B. Colonoscopy completion rates after positive Cologuard test comparing post-navigator cohort and 2023 (pre-naviagtor) cohort (p=0.0009)

Table C. Days to Colonoscopy following positive Cologuard test comparing Post-navigator cohort and 2020 cohort (p < 0.0001)

Table D. Days to Colonoscopy following positive Cologuard test comparing Post-Navigator cohort and 2023 (pre-navigator) cohort (p=0.4237)


Disclosures:
Joshua Freeman indicated no relevant financial relationships.
Miranda Hart indicated no relevant financial relationships.

Joshua Freeman, DO¹, Miranda Hart, MD². P4788 - The Impact of a Patient Navigation System on Colonoscopy Completion Rates, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.