S518 Assessing Adherence to Evidence-Based Guidelines for Colorectal Cancer Screening in Foreign-Born Patients in a Primary Care Clinic

Introduction: Foreign-born individuals in the U.S. make up 14% of the population. In New Jersey (NJ), 24% of the population is foreign-born. Colorectal cancer (CRC) screening rates in the U.S. are lower in foreign-born individuals, and barriers to preventive care access by foreign-born individuals in the U.S. are well-documented. The goal of our QA/QI study is to assess whether we are adhering to United States Preventive Services Task Force guidelines for colorectal cancer (CRC) screening among foreign-born patients in our primary care clinic in Newark, NJ. Methods: Retrospective chart review of patients seen in the Medicine-Pediatrics clinic in 2023 who were aged 45-75 years old. Symptomatic patients (blood in the stools, new changes in bowel habits, abdominal pain, new diagnosis of anemia, unintended weight loss) and patients with a past medical or family history of colorectal cancer or IBD were excluded. Patients with limited English proficiency (LEP) who require interpreter services were assumed to be, by extension, foreign-born. After applying exclusion criteria, the final study sample size was 80 patients. The primary outcome was whether a colonoscopy had been performed within the past 10 years. The secondary outcome was the rate of interpreter use. Comparisons were done using a 2-tailed t-test with a significance threshold of P < 0.05. Results: Out of 80 patients, 28% had LEP compared to a national average of 8.6%. The overall CRC screening rate in our clinic was 73%, which is comparable to the statewide average of 72%. The CRC screening rate in patients with LEP was 59% compared to 78% in patients who are English proficient (P = 0.098). The rate of interpreter use in our clinic was 41% compared to a national average of 30%. Conclusion: In this quality assurance portion of a QA/QI study aimed at improving CRC screening rates in our primary care clinic, we found that CRC screening rates were lower in patients with LEP. These results are not statistically significant but are clinically significant, with P-values approaching significance. Next steps will include increasing the sample size to enhance the study's power and implementing targeted interventions, such as distributing CRC screening brochures in various languages and flyers in examination rooms to remind providers to use and document the use of interpreter services. Rates of CRC screening will be reassessed after the implementation of these interventions.