Abstracts

Attrition in the critical clinical steps between abnormal FIT and follow-up colonoscopy in a large Federally Qualified Health Center

Megan R. McLeod, MD, MSCR; Jessica Tuan, MPH; Beth A. Glenn, PhD; Alison K. Herrmann, PhD, MS; Analissa Avila, MS; Debra Rosen, RN, MPH; Catherine M. Crespi, PhD; Narissa Nonzee, PhD; Christine Park, MD, MPH, CLE, FAAP; Alicia Lwin, MD; Joanna Quintanilla, CHES, CLE; Roshan Bastani, PhD; Folasade P. May, MD, PhD, MPhil

Introduction: The fecal immunochemical test (FIT) is an affordable and effective colorectal cancer screening method if completed annually and if individuals with an abnormal result undergo timely follow-up colonoscopy. This process is challenging in Federally Qualified Health Centers (FQHCs), where millions of low-income patients receive primary care services, and where follow-up colonoscopy requires referral to outside providers. We aimed to determine the critical clinical steps between abnormal FIT and colonoscopy and to calculate attrition rates at each of these steps in one of the largest FQHCs in the United States.

Colorectal cancer screening rates at Federally Qualified Health Centers in the United States from 2020 to 2021: Incomplete rebound and worsening disparities

Matthew Y. Zhao, BS; Yvonne Y. Lei, BS; Megan R. McLeod, MD, MSCR; Jayraan Badiee, MPH; Artin Galoosian, MD, MS; Folasade P. May, MD, PhD, MPhil

Introduction: Federally Qualified Health Centers (FQHCs) offer preventive health services, including colorectal cancer (CRC) screening, for low-income and under-insured individuals in the United States (U.S.). CRC screening rates in FQHCs increased from 2014 to 2019 but declined in 2020, coinciding with the beginning of the COVID-19 pandemic. We assessed changes in CRC screening rates and clinic-level factors associated with changes in screening rates from 2020 to 2021 in U.S. FQHCs.

Comparison of four population health interventions to increase colorectal cancer screening in young adults: Results of a randomized trial

Artin Galoosian MD, MS; Daniel Croymans MD, MBA; Hengchen Dai PhD; Silvia Saccardo PhD; Craig R. Fox, PhD; Gregory Goshgarian, MD; Sadie De Silva, MD; Maria A. Han, MD; Sitaram Vangala, MS; Folasade P. May, MD, PhD, MPhil

Introduction: Colorectal cancer (CRC) incidence and mortality have increased in young adults in the United States, prompting several new guidelines that promote screening individuals starting at age 45. Effective population health strategies to screen these individuals have not yet been established. Thus, we aimed to determine effective outreach strategies to maximize screening participation among patients aged 45-49 in a diverse health system.

Delay to treatment, socioeconomic status, and race/ethnicity are associated with increased mortality from hepatocellular carcinoma: Results from the surveillance, epidemiology, and end results cancer registry

Aileen Bui, MD; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths in the United States (US) and has rising incidence and mortality. HCC disproportionately impacts low-income and racial/ethnic minority populations. These disparities are multifactorial; however, the impact of timely treatment on HCC disparities is understudied. We aimed to examine the impact of race/ethnicity, socioeconomic status (SES), and time to treatment on mortality in individuals age ≥18 with HCC.

Does dietary fiber enhance re-establishment of the gut microbiome composition following colonoscopy?

Claire E. Kim, PhD, MPH; Carra Simpson, PhD; Folasade P. May, MD, PhD, MPhil; Jamie O. Yang, MD; Jonathan P. Jacobs, MD, PhD; Marc C. Kaneshiro, MD; Terri E. Getzug, MD; Karin B. Michels, ScD, PhD

Introduction: Colorectal cancer (CRC) is the fourth most diagnosed cancer and second most common cause of cancer-related deaths among men and women in the United States. Recent experimental evidence has suggested a potential role for the gut microbiome in CRC pathogenesis. Prebiotic supplements have been observed to affect gut microbial diversity in animal and human studies, suggesting a chemopreventive effect on colorectal neoplasia. The present study aims to investigate whether soluble dietary fiber, xylooligosaccharides (XOS), enhances the re-establishment of the gut microbiome composition following exposure to prescription laxatives.

Food insecurity is associated with lack of up-to-date colorectal cancer screening in a large, national survey in the United States

Yvonne Lei, BA; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: Food insecurity (FI) has been associated with low access to healthcare services, poor health outcomes, and health disparities. However, little is known about the relationship between FI and colorectal cancer (CRC) screening and outcomes. Thus, we aimed to examine the association between FI and utilization of CRC screening in the United States.

Impact of a multicomponent health system intervention to increase colorectal cancer screening participation in patients with a family history of colorectal cancer

Shailavi Jain, MD; Artin Galoosian, MD, MS; Jayraan Badiee, MPH; Sarah Meshkat, MHA; Folasade P. May, MD, PhD, MPhil

Introduction: Family history of colorectal cancer (CRC) is a risk factor for CRC and contributes to one-third of cases in the United States. Health system interventions to increase CRC screening often exclude these high-risk individuals, and few interventions that increase screening participation in this population have been published. We designed, implemented, and evaluated the impact of a multicomponent health system intervention designed to increase CRC screening uptake among individuals with a documented family history of CRC.

Impact of state Medicaid expansion status on colorectal cancer screening rates and predictors of screening at U.S. Federally Qualified Health Centers

Megan R. McLeod, MD, MSCR; Matthew Y. Zhao, BS; Yvonne Lei, BS; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: Medicaid expansion is a provision in the Affordable Care Act that increases access to health insurance and preventive services for low-income individuals, however not all U.S. states participate. Individuals with Medicaid and in medically underserved areas often receive preventive services at Federally Qualified Health Centers (FQHCs). We aimed to study the impact of Medicaid expansion on colorectal cancer (CRC) screening rates in FQHCs by comparing CRC screening rates and predictors of screening in FQHCs in Medicaid expansion and non-expansion states.

Integrating artificial intelligence with clinical dashboards to measure screening colonoscopy quality indicators for large health systems

Jaime O. Yang, MD; Sadie De Silva, MD; Cleo Maehara, MD; Alexandria Uy; Emma Kate Peterson; Artin Galoosian, MD, MS; Camille Soroudi, MD; Anthony Myint, MD; William Hsu, PhD; Yuna Kang, MD; Bita V. Naini, MD; V. Raman Muthusamy, MD, MS; Eric Esrailian, MD, MPH; Folasade P. May, MD, PhD, MPhil

Optimizing primary care physician attribution strategies for health system interventions to increase colorectal cancer screening rates

Shailavi Jain, MD; Sarah Meshkat, MHA; Folasade P. May, MD, PhD, MPhil

Introduction: There is increasing attention in health systems to implement interventions that increase patient participation in colorectal cancer (CRC) screening. Our large academic health system has a well-established biannual mailed fecal immunohistochemical test (FIT) outreach program that mails FIT kits to average-risk patients overdue for CRC screening. This program, and many similar programs nationally, exclude patients without an attributed primary care physician (PCP) due to lack of a provider to act on abnormal results. Nationally, many programs struggle to develop a PCP attribution model that accurately excludes patients without an active PCP. We aimed to assess the accuracy of the PCP attribution model developed in our health system for our mailed FIT outreach program with the goal to optimize attribution for future mailing cycles.

Patient factors predict receipt of and time to follow-up colonoscopy after abnormal FIT in a large Federally Qualified Health Center

Megan R. McLeod, MD, MSCR; Jessica Tuan, MPH; Beth A. Glenn, PhD; Alison K. Herrmann, PhD, MS; Analissa Avila, MS; Debra Rosen, RN, MPH; Catherine M. Crespi, PhD; Narissa Nonzee, PhD; Christine Park, MD, MPH, CLE, FAAP; Alicia Lwin, MD; Joanna Quintanilla, CHES, CLE; Roshan Bastani, PhD; Folasade P. May, MD, PhD, MPhil

Introduction: Fecal immunochemical test (FIT) effectiveness for colorectal cancer (CRC) prevention and early detection is contingent on timely colonoscopy after abnormal results. Receipt of follow-up colonoscopy is low in safety-net settings, including Federally Qualified Health Centers (FQHCs), which provide primary care services to 30 million Americans annually. We aimed to determine patient factors associated with receipt of, and time to, follow-up colonoscopy in one of the largest FQHCs in California.

Performance of an automated natural language processing tool to identify guideline-concordant surveillance intervals after screening colonoscopy

Camille Soroudi, MD; Sadie De Silva, MD; Emma Kate Peterson; Cleo Kaiaki Maehara, MD; Jayraan Badiee, MPH; Anthony Myint, MD; V. Raman Muthusamy, MD, MS; Eric Esrailian, MD, MPH; William Hsu, PhD; Folasade P. May, MD, PhD, MPhil

Introduction: Accurate determination and documentation of post-polypectomy surveillance
intervals for screening colonoscopy is essential to reduce colorectal cancer (CRC) incidence
and mortality. It is particularly important to ensure timely surveillance for patients with high-risk
polyps that warrant 3-year follow-up. In order to improve guideline-concordant surveillance after
screening colonoscopy, we sought to validate a previously developed natural language
processing (NLP) algorithm that automates determination of post-polypectomy colonoscopy
surveillance intervals.

The impact of the revised USPSTF screening guidelines on racial and ethnic differences in colorectal cancer screening rates in a Boston healthcare system

Adjoa Anyane-Yeboa, MD, MPH; Jennifer Haas, MD, MSc; Roopa Bhat, BS; Suzanne Brodney, PhD; Yuchiao Chang, PhD; Folasade P. May, MD, PhD, MPhil

Introduction: Incidence of colorectal cancer (CRC) has been increasing in individuals age < 50 years for the past several decades. This rising incidence prompted the United States Preventive Services Task Force to revise their CRC screening recommendations in May 2021 to include screening individuals age 45 to 49. With this guideline change, there was a sudden increase in the number of screening-eligible individuals. As this younger population is more racially/ethnically diverse than the older population in the US, the sociodemographic characteristics of this “new to CRC screening” population may require different outreach and education. The objective of our study is to evaluate the impact of the updated screening guidelines on screening rates and the characteristics of the unscreened population in a large health system.

Race/ethnicity and socioeconomic status are associated with delayed time to treatment in patients with hepatocellular carcinoma: Results from the surveillance, epidemiology, and end results cancer registry

Aileen Bui, MD; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: Hepatocellular carcinoma (HCC) is a major complication in patients with cirrhosis and a leading cause of cancer-related deaths in the United States (US). Delays in initiation of treatment are associated with poor HCC outcomes; however, factors that predict time to treatment are underexplored. We aimed to examine differences in time to treatment by race, ethnicity, and socioeconomic status (SES) in adults with HCC.

The effectiveness of automated reminder calls to increase colonoscopy completion rates after abnormal fecal immunochemical test results

Oliva J. Jordan, MD; Jiwen Li, MD; Anjani Reddy, MD, MPH; Amit Kothari, MD; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: The fecal immunochemical test (FIT) is effective in reducing colorectal cancer (CRC) incidence and mortality. In many Veterans Health Administration (VA) facilities, FIT is the preferred method for CRC screening for average-risk individuals. However, a challenge with FIT screening is that an abnormal test must be followed by colonoscopy. Effective interventions to increase colonoscopic completion after abnormal FIT are lacking. We implemented and assessed the impact of an automated reminder call to patients with an abnormal FIT result on colonoscopy completion in a Veteran population.

Trends in mailed fecal immunochemical test outreach response rates from 2018 to 2022 in a large academic health center

Shailavi Jain, MD; Sarah Meshkat, MHA; Folasade P. May, MD, PhD, MPhil

Introduction: Colorectal cancer (CRC) remains common and deadly despite national screening guidelines and multiple screening modalities. Screening rates declined during the COVID-19 pandemic, and the pandemic impacted health system CRC screening interventions, including mailed fecal immunochemical test (FIT) outreach. We aimed to evaluate trends in response rates to mailed FIT outreach in our health system before, during, and after the COVID-19 pandemic.

Using a clinical dashboard to track colorectal cancer screening rates and modalities in a large integrated health system

Sadie De Silvia, MD; Jordan Olivia, MD; Amarachi Erondu, MD; Sarah Meshkat, MBA; Shelly J. Dumaguindin; Juyea Hoo; Sean H. Furling; Anna Dermenchyan, MSN, RN, CCRN-K; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: The measurement of colorectal cancer (CRC) screening rates is imperative for quality reporting and population health management. Tracking screening rates is difficult in real-time and complicated by changes in clinical guidelines, clinical practice, and other regional and national events. We developed and validated a clinical dashboard that tracks real-time population health CRC screening data in a large health system.