Increasing Fecal Immunochemical Testing (FIT) for Colorectal Cancer Screening
William Degan, MD; James Lui, MSc; Barry Coutinho, MD
Background
Colorectal cancer (CRC) screening for ages 50-75 is supported by the strongest level of evidence and results in reduced mortality rates. Shadyside Family Health Center (SFHC) has overall screening rates that are similar to the national average but below CDC and Healthy People 2020 targets, and specifically low rates of fecal immunochemical testing (FIT). Our objective was to increase FIT utilization at SFHC.
Methods
Chart review of nurse visit encounters over a six-month period identified 30 patients who were both due for CRC screening and eligible for FIT. We also reviewed cases of outstanding FIT orders and methods for increasing completion rates, including using a standing order for FIT. We educated providers on CRC screening guidelines and how to order FIT via didactic presentations and huddle reminders.
Results
Upon subsequent review of nurse visit encounters, we found that screening was not attempted in one-third of the previously identified cases. Educational interventions with providers were associated with an increase in FIT ordering (22 to 108 tests per year) and completion (6 to 36 results per year) over time. Overall CRC screening rates did not increase which we attribute primarily to continued low rates of completion for all screening methods.
Discussion
Nurse visits may provide an opportunity to screen a modest number of additional patients if a standing order for FIT is implemented in the future.
Conclusion
FIT is an underutilized method of CRC screening and provides an opportunity to increase CRC screening rates at the SFHC in the future.