Clinic disparities in colorectal cancer screening among people experiencing homelessness and first-round quality improvement initiatives.

481 Background: People experiencing homelessness (PEH) face higher cancer-related mortality and longer delays in cancer screening and treatment than their housed counterparts. These disparities extend to colorectal cancer (CRC) screening, with fewer fecal immunohistochemical test (FIT) completions among PEH, and targeted interventions have rarely been studied. Methods: This ongoing Lean quality improvement project aims to improve CRC screening rates in PEH, defined as unsheltered, in shelters or transitional housing, “doubling up”, or with “homeless status unknown”. The practice setting is The People Concern Annenberg Access Center (OPCC), which is one of several clinical sites within Venice Family Clinic (VFC), a federally qualified health center in Los Angeles. Clinic disparities in CRC screening were analyzed, followed by observation of clinic practices and informal staff interviews. After root cause analysis, the first plan-do-study-act cycle launched in April 2025 with a planned 6-month intervention period. Categorical proportions were evaluated with Chi-square tests. Results: From February 2024 to January 2025, 88.1% (208/236) of CRC screening-eligible patients at OPCC were homeless, compared to 12.9% (1891/14,660) across all other VFC sites. Screening rates for eligible PEH were lower compared to housed patients both at OPCC (22.1% vs. 39.3%, p = 0.08) and systemwide (27.4% vs. 52.9%, p < 0.05). PEH at OPCC were primarily screening adherent by FIT completion (29/46; 63.0%) and were adherent by colonoscopy less frequently than were PEH across all other VFC sites (37% vs. 40.6%, p < 0.05). Other subgroups with the lowest CRC screening rates at OPCC were patients with severe mental illness (38/124; 28.3%), female patients (17/75; 22.7%), Black/African American patients (15/80; 18.8%), those aged 45-49 (5/36; 13.9%), and those who were uninsured (18/142; 12.7%). Next, across all VFC sites from January 2023 to June 2023, screening-eligible PEH had significantly fewer FITs ordered by providers than eligible housed patients (31.1% [353/1136] vs. 50.7% [3113/6136], p < 0.05). Out of 7 FIT-positive PEH from these orders, only 3 completed colonoscopies within 12 months of positive result. Finally, clinic observations and interviews identified several barriers, such as inefficient staff roles and poor access to flushable toilets. Targeted interventions at OPCC include a FIT incentive program, clinic flyers, and a standardized “bathroom plan” discussion between providers and patients. Conclusions: CRC screening rates are low among PEH at VFC due to clear demographic, provider, and structural factors. Multiple interventions are underway at OPCC with ongoing study of outcome, process, and balancing measures. Future planned interventions include leveraging an existing motel referral program and targeting colonoscopy completion in quality efforts.