S544 Effects of Centralized Management of Fecal Immunochemical Test (FIT) Results on Adherence to Follow-Up Colonoscopy

Introduction: Despite major advances in colorectal cancer prevention using colonoscopy, many people remain unscreened. Starting in 2019, a program of fecal immunochemical test (FIT) testing was initiated in the primary care medical clinic at our hospital, which serves a disadvantaged, inner-city population. Our initial experience demonstrated a high yield of adenomas, advanced adenomas, and cancers in FIT positive (FIT+) patients studied between 2019-2021. However, a minority of the FIT+ patients underwent colonoscopy. In this follow up study, we examined the effect of centralizing the follow up management and navigation of FIT+ patients, as compared to our historical control group. Methods: In 2022, the GI patient navigators were given the responsibility for following up FIT+ results, instead of primary care providers. We retrospectively compared patients with FIT+ results from January 2022 to February 2025 (post-centralizing group) to patients who tested FIT+ from July 2019 to December 2021 (pre-centralizing group). We analyzed completion of follow-up colonoscopy, reasons for nonadherence, and colonoscopy yield. Results: Three hundred eighty five FIT+ were identified between 2019-2025, with 174 patients in pre-centralizing group and 211 in post-centralizing group. Patients in post-centralizing group were younger (mean age, 63 vs 61 years old, P = 0.008), and more African American (30.5% vs 41.2%, P = 0.001). No significant difference was found in gender. More patients in the post-centralizing group were given a colonoscopy order (75.9% vs 84.8%, P = 0.026) and completed colonoscopy (46% vs 61.6%, P = 0.001), increasing adherence by 33.4%. The effect is more clearly observed in patients for ‘screening,’ who did not have lower GI symptoms or anemia, for whom adherence rose from 41.7% to 62.5% (P = 0.001), a 49.9% increase. Reasons for nonadherence were predominantly patient-related (61.7% vs 69.1%). No significant differences were found in the timeliness of follow-up procedure, or detection rates of advanced adenoma or cancer. Conclusion: Centralizing follow up and navigation improved adherence to colonoscopy in FIT+ patients by 33.4% overall, and 49.9% in patients without GI symptoms or anemia. However, 38.4% did not undergo colonoscopy, with patient refusal being the major reason. Further efforts to improve adherence through enhanced education of the implications of FIT+ are ongoing.