Colorectal cancer (CRC) screening was significantly curtailed due to the COVID-19 pandemic and Hines VA Medical Center in Illinois performed 50% fewer screening colonoscopies in 2020 compared to 2019 (pre-pandemic). This quality study aimed to increase use of fecal immunochemical tests (FIT) as an alternative screening method while in-person screening was limited. The primary goal was to return to pre-pandemic rates of screening (colonoscopy + FIT) and the secondary goal was to increase monthly screenings by 10% to address the backlog of patients not screened early in the pandemic.
Using Plan-Do-StudyAct (PDSA) quality improvement methodology, a multidisciplinary team led by Primary Care, Gastroenterology and Laboratory/Pathology services, standardized processes for dissemination and processing of FIT tests. The first PDSA cycle implemented utilization of Colorectal Cancer Screening & Surveillance Clinical Reports (CRCS/S) to identify average-risk patients due or overdue for screening, devised plain language patient instructions for FIT-based testing, and formalized a mechanism for tracking FIT test kits.
Baseline number of CRC screenings in 2019 was 2,808 (750 colonoscopy + 2,058 FIT). After the first PDSA cycle, CRC screenings were recorded during the 12-month period from April 2021 to March 2022. Colonoscopy + FIT increased to 3,558, largely due to an increase in completed FIT tests (362 colonoscopy + 3,196 FIT tests). While the number of screening colonoscopies was 52% lower compared to 2019, the number of patients screened with FIT increased by 55% after the intervention. Colonoscopy + FIT in the 12 month period starting in April of 2021 exceeded that of 2019, supporting the fact that stoolbased FIT testing was a feasible approach to screening average risk patients while in-person screening activities were restricted.
This quality improvement study met the primary goal of returning to pre-pandemic rates of colonoscopy + FIT and the secondary goal of increasing average number of monthly screenings by 10% to address the backlog of patients not screened early in the pandemic. Interventions directed at optimizing the FIT test process were associated with an increase in completed FIT tests. Planned PDSA cycle two will implement a mailed FIT Outreach pilot to reach additional patients for CRC screening.