Implementing an Organized Colorectal Cancer Screening Program: Lessons Learned From an Academic-Community Practice

Amanda Kimura; Ari Bell-Brown; Nkem Akinsoto; Jerry Wood; Amy Peck; Victoria Fang; Rachel B Issaka

doi:10.1016/j.focus.2024.100188

Implementing an Organized Colorectal Cancer Screening Program: Lessons Learned From an Academic-Community Practice

AJPM Focus. 2024 Jan 7;3(2):100188. doi: 10.1016/j.focus.2024.100188. eCollection 2024 Apr.

Authors

Amanda Kimura¹, Ari Bell-Brown¹, Nkem Akinsoto², Jerry Wood², Amy Peck², Victoria Fang³, Rachel B Issaka^{1

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Affiliations

¹ Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, Washington.
² UW Medicine Primary Care and Population Health, University of Washington, Seattle, Washington.
³ Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington.
⁴ Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington.
⁵ Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington.

Abstract

Introduction: The effectiveness of mailed fecal immunochemical test outreach might be enhanced through an organized colorectal cancer screening program, yet published real-world experiences are limited. We synthesized the process of implementing a colorectal cancer screening program that used mailed fecal immunochemical test outreach in a large integrated academic-community practice.

Methods: Data from a pilot mailed fecal immunochemical test program were shared with healthcare system leadership, which inspired the creation of a cross-institutional organized colorectal cancer screening program. In partnership with a centralized population health team and primary care, we defined (1) the institutional approach to colorectal cancer screening, (2) the target population and method for screening, (3) the team responsible for implementation, (4) the healthcare team responsible for decisions and care, (5) a quality assurance structure, and (6) a method for identifying cancer occurrence.

Results: The Fred Hutch/UW Medicine Population Health Colorectal Cancer Screening Program began in September 2021. The workflow for mailed fecal immunochemical test outreach included a mailed postcard, a MyChart message from the patient's primary care provider, a fecal immunochemical test kit with a letter signed by the primary care provider and program director, and up to 3 biweekly reminders. Patients without a colonoscopy 3 months after an abnormal fecal immunochemical test result received navigation through the program. In the first program year, we identified 9,719 patients eligible for outreach, and in an intention-to-treat analysis, 32% of patients completed colorectal cancer screening by fecal immunochemical test or colonoscopy.

Conclusions: Real-world experiences detailing how to implement organized colorectal cancer screening programs might increase adoption. In our experience, broadly disseminating pilot data, early institutional support, robust data management, and strong cross-departmental relationships were critical to successfully implementing a colorectal cancer screening program that benefits all patients.

Keywords: Colorectal cancer; colonoscopy; fecal immunochemical test; organized screening; population health; screening.

Grants and funding

K08 CA241296/CA/NCI NIH HHS/United States