Screening Colonoscopy After a Positive Stool-based Test

ASGE Quality Endoscopy Unit Recognition Program

Successful applicants to the ASGE Endoscopy Unit Recognition Program submit a summary of a recently conducted quality improvement (QI) project as part of the application process. This month we offer a sample quality improvement project plan to get you started on increasing the public’s knowledge of the importance of screening colonoscopy and colonoscopy after a positive fecal immunochemical test (FIT) or FIT-DNA test.

Quality Improvement Project Sample

In the United States, it is estimated that more than 52,000 people will die of colorectal cancer in 2022, and roughly 151,000 new cases will be diagnosed; this makes colorectal cancer the second leading cause of cancer-related death and the fourth most diagnosed cancer site.1

Despite improved uptake of screening colonoscopy, which is credited for the accelerated decline in colorectal cancer incidence and mortality since 2000, one-third of eligible adults are still not up to date with colorectal cancer screening, and disparities of colorectal cancer among racial and ethnic populations are striking.2

Attention must be paid to reducing disparities in preventive colorectal cancer screening, early cancer detection and patient outcomes. Achieving equity in colorectal screening and outcomes requires that physicians and other health care providers work together to improve access to screening tests and to increase screening rates. Far too often, patients are handed a prescription or referral for a colorectal cancer screening test, but they do not fully understand how to complete their screening, or they do not fully understand their screening options.

We chose to start an improvement project to increase the public’s knowledge of the importance of screening colonoscopy and colonoscopy post positive FIT-DNA or FIT.

PLAN

A multidisciplinary team was formed to discuss how we could improve the number of referrals for screening colonoscopies and for colonoscopies after a positive DNA-FIT or FIT.

  • The team reviewed materials provided by ASGE through the society’s Value of Colonoscopy Campaign and formulated a plan to educate patients not getting a screening colonoscopy at 45 years old or following up on a positive test from other screening modalities to see whether this education would change their mind about getting a colonoscopy or following up on a positive FIT-DNA or FIT.
  • Describe the plan.
  • The team planned to create data collection sheets and an XLS file to aggregate the data to track the number of patients who were aged 45 years or older who have never had a screening colonoscopy, a positive FIT-DNA test or a positive FIT and followed up on a referral.
DO
  • Describe deployment of your plan including time of intervention.
  • Staff was educated on the plan and instructed on how to record referral-based colonoscopies on the data collection sheet and how that information would be aggregated in the XLS file at the end of the project period.

STUDY

Our goal was to track our conversions rate(s) to procedure completion, specifically as follows.

  • Number of patients aged 45 or older requesting referral for screening colonoscopy
  • Number of these patients who completed screening colonoscopy
  • Calculate the conversion rate (completed screens/referrals)
  • Number of patients aged 45 or older who had an appropriate indication for a FIT-DNA test* and had a positive FIT-DNA test, requesting a referral for colonoscopy
  • Number of these patients who completed colonoscopy
  • Calculate the conversion rate (completed colonoscopies/referrals)
  • Number of patients aged 45 or older who did not have an appropriate indication for a FIT-DNA test* and had a positive FIT-DNA test, requesting a referral for colonoscopy
  • ­Number of patients aged 45 or older who had an appropriate indication for FIT* and had a positive FIT, requesting a referral for colonoscopy
  • ­Number of these patients who completed colonoscopy
  • ­Calculate the conversion rate (completed colonoscopies/referrals)
  • Number of patients aged 45 or older who did not have an appropriate indication for FIT* and had a positive FIT test, requesting a referral for colonoscopy

*The appropriate indication for a FIT-DNA test or FIT is patients aged 45 or older without symptoms, without prior colorectal cancer or polyps and without any of the factors that define high-risk screening.

The steps we took were as follows:

  1. To get the number of referred patients for screening colonoscopy or colonoscopy after a positive FIT-DNA test or FIT, we worked with our scheduler to pull the numbers from our software.
  2. To get the number of patients who completed colonoscopy, we entered the data sheets in an XLS file and tallied the results.
  3. We calculated the conversion rates for each, using the formulas noted above.
  4. To get the number of patients who did not have an appropriate indication for a FIT-DNA test or FIT* and had a positive FIT-DNA test or FIT, requesting a referral for colonoscopy (as in Step 2), we entered the data sheets in the XLS file and tallied the results.

Describe your results.

ACT

Describe your plans for reporting out and moving forward.

We hope sharing this sample quality improvement project plan will get you started on increasing the public’s knowledge of the importance of screening colonoscopy and colonoscopy after a positive FIT-DNA test or FIT. Questions should be directed to eurp@asge.org.

References

  1.  American Cancer Society. Cancer Facts & Figures 2022. Atlanta: American Cancer Society; 2022. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2022.html  
  2. Ibid.