Christina Dimaria, DO, RD1, Abhinav Goyal, MD1, Taylor Dorman1, Michael E. Goldberg, DO2; 1Albert Einstein Medical Center, Philadelphia, PA; 2Einstein Healthcare Network, Philadelphia, PA
Introduction: Colorectal cancer (CRC) is the second leading cause of cancer related death in the US. CRC screening rates have increased from 67% in 2016 to 69% in 2018 in the US, yet more than 30% of the population remains without screening. Colonoscopy is the gold standard for CRC screening. There are several barriers to this life saving procedure including multiple office visits, procedure scheduling, wait times, etc. The Direct Access Colonoscopy (DAC) program is a collaboration between primary care physicians (PCPs) and gastroenterologists that allows healthy, age-appropriate patients to directly schedule a colonoscopy. We present our experience with the DAC program over nine months and its effect on population CRC screening rates. Methods: A multi-disciplinary workgroup of PCPs, gastroenterologists, healthcare coordinators, and population health analysts was created. Inclusion and exclusion criteria to qualify for DAC were developed. After a short pilot period, the program was implemented in Jan. 2019. After being referred by PCPs or self-referred, patients were screened by DAC coordinators using the pre-set criterion. The patients who qualified for DAC were scheduled for colonoscopy. To calculate population screening rate, HealtheIntentSM (Cerner corp., MO) platform which combines claims data and electronic medical record data was used to identify patients needing age appropriate screening. The number of patients referred for DAC, those passing or failing initial screening, and those that were unable to be contacted, were identified. Failure to qualify for DAC after screening prompted an office visit for evaluation. Variables were summarized using percentage. Microsoft Excel 15.0 (Microsoft Corp., WA) was used for all analysis. Results: A total of 5157 patients were referred to the DAC program (Jan. - Sept. 2019). 2872 patients were not screened due to inability to contact. Of 2285 patients screened for DAC, 46% met criteria and were scheduled for colonoscopy. Most common reasons to not qualify were cardiac disease (21.9%) followed by gastrointestinal symptoms (18.5%). There was a consistent improvement in population CRC screening rate of 0.5-1% per month after initiation of the program. Year to date, there has been a 5.4% absolute increase in CRC screening rate of our population (Figure 1). DAC referrals from PCPs have increased steadily as well (Figure 2). Discussion: DAC is a simple and novel multidisciplinary collaboration that increases CRC screening by decreasing logistical barriers.
5.4% absolute increase in CRC screening rate after implementation of DAC program
DAC referrals from primary care physicians have increased steadily since implementation of DAC program
Disclosures: Christina Dimaria indicated no relevant financial relationships. Abhinav Goyal indicated no relevant financial relationships. Taylor Dorman indicated no relevant financial relationships. Michael Goldberg indicated no relevant financial relationships.