S421 System-Based and Culturally Responsive Interventions to Enhance CRC Screening Uptake in a Safety Net Clinic

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the U.S. Despite recommendations for screening at age 45, only 68.8% of eligible adults complete CRC screening, with lower rates among racial/ethnic minorities, low-income patients, and those with limited health literacy. At Hartford Healthcare Adult Primary Care Clinic, serving a Hispanic/Latino population with 65% on Medicaid or self-pay, only 113 multitarget stool DNA (mt-sDNA) orders and 254 screening colonoscopy referrals (SCR) were recorded from September 2022 through August 2023. The goal was to increase mt-sDNA orders by 50% (from 113 to 170) and SCR by 50% (from 254 to 381) by August 2024, with a focus on improving screening engagement among Spanish-speaking patients. Methods: We conducted a prospective quality improvement initiative. Pre-intervention data were collected from September 2022 to August 2023 (baseline), and post-intervention data from September 2023 to August 2024 (intervention). Starting September 1, 2023, our multifaceted intervention included: (1) biweekly educational sessions for all resident and attending physicians on CRC screening guidelines, mt-sDNA order workflows, and cultural competence; (2) integration of a mt-sDNA prompt into the electronic medical record’s Best Practice Advisory; and (3) distribution of bilingual (English/Spanish) patient education pamphlets and QR-linked instructional videos. Outcomes—mt-sDNA orders and SCR referrals were aggregated into 8 consecutive 3-month periods, and pre- versus post-intervention proportions were compared using chi-square tests (α = 0.05) and Poisson log-linear model. Results: After adjusting for quarterly clinic volume in a Poisson log‐linear model, the rate of mt-sDNA orders increased by 70% following the intervention (incidence-rate ratio [IRR] = 1.70; 95% confidence interval [CI] 1.35–2.14; P < 0.001), and overall screening actions rose by 27% (IRR = 1.27; 95% CI 1.11–1.46; P = 0.0005). Combined screening actions increased significantly more among Spanish-speaking patients (χ²₁ = 4.53; P = 0.03) and Hispanic patients (χ²₁ = 4.80; P = 0.028) than among their counterparts. Conclusion: Embedding mt-sDNA orders into electronic medical record workflows and reinforcing its use through targeted provider education and culturally tailored patient materials significantly improved CRC screening uptake, among underserved Spanish-speaking patients. Future work will evaluate mt-sDNA completion rates and integrate patient navigation to optimize follow-through after positive test results.