PRP189: Using Risk Prediction to Target Navigation for Follow-Up Colonoscopy in Community Health Centers

Amanda Petrik


Colorectal cancer (CRC) screening by annual fecal immunochemical test (FIT) is an accessible and cost-effective strategy to lower CRC incidence and mortality. However, this mode of screening depends on follow-up colonoscopy after a positive FIT result. Unfortunately, nearly one-half of FIT-positive patients fail to complete this essential screening component. Patient navigation may improve follow-up colonoscopy adherence. To deliver patient navigation cost-effectively, health centers could target navigation to patients who are unlikely to complete the procedure on their own.
The Predicting and Addressing Colonoscopy Non-adherence in Community Settings (PRECISE) clinical trial developed a risk model of follow-up colonoscopy adherence and is testing whether patient navigation raises rates of colonoscopy adherence overall and among patients in each probability stratum (low, moderate, and high probability of adherence without intervention).
Study Design and Analysis:
The risk prediction model consists of 17 patient level variables that predict the probability of completing a follow-up colonoscopy. The variables in the model include demographics (age, race, language, gender, insurance, marital status, homelessness, and county of residence), and clinical factors (flu shot history, BMI, prior screening, hemorrhoids, blood in the stool, the Gagne comorbidity score, number of prior appointments and prior missed appointments). The reduced model showed adequate separation of patients across risk levels for non-adherence to follow-up colonoscopy (C-statistic 0.65, bootstrap-corrected >0.61).
Setting and Population Studied:
PRECISE is a collaboration with a large community health center whose patient population is 37% Latino. Eligible patients were aged 50-75, had an abnormal FIT result in the past month, and are due for a follow-up colonoscopy. Patients are randomized to patient navigation or usual care. To-date, 220 patients have been randomized (recruitment target = 1200).
Outcome Measures:
This innovative clinical trial is testing the effectiveness and financial feasibility of using a precision health intervention to improve colorectal cancer screening completion in community health centers.

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