Barriers to Timely Colonoscopy Completion Following Abnormal Fecal Immunochemical Test Results in a Safety-net System

We conducted this retrospective chart review within an integrated safety-net system primarily serving low-income populations. The system includes 12 primary care clinics that refer patients to a single gastroenterology (GI) clinic. Using the electronic health record (EHR), we identified patients with an abnormal FIT between September 2021 and March 2023. We manually reviewed 222 consecutive patient records using a standardized abstraction protocol. We located the FIT date and searched the EHR using the keywords “gastroenterology,” “colonoscopy,” “abnormal FIT,” and “positive FIT.” We continued abstraction until no new information was identified. We developed a data extraction form in Microsoft Access to standardize data collection. The form included dropdown fields to categorize EHR-documented incomplete colonoscopy within six months of an abnormal FIT: (a) patient declined colonoscopy, (b) inability to reach the patient, (c) inadequate follow-up, and (d) comorbidities. When we identified other reasons, we documented them in a free-text box. All categories were mutually exclusive. We identified 728 patients with an abnormal FIT between September 2021 and March 2023. Of these, 65% (472/728) were referred to GI, 66% (311/472) of those who were referred were scheduled for a colonoscopy, and 84% (262/311) who were scheduled completed their colonoscopy within six months of the abnormal FIT date, or an overall six-month colonoscopy completion rate of 36%. We conducted a detailed EHR review of 222 consecutive patients from among the 469 who did not undergo a colonoscopy. We found that 7% ( n = 15/222) were scheduled for colonoscopy and 15% ( n = 33/222) had completed their colonoscopy more than six months after their abnormal FIT. Of the 7% of patients with an abnormal FIT scheduled for a colonoscopy, 4% completed their procedure. Among those who completed their colonoscopy more than six months after their abnormal FIT, the median timeframe was 318 days (IQR: 254–451), or approximately 10 months. The most frequently documented reasons for incomplete follow-up colonoscopy are listed in the Table 1 : patient declined to complete colonoscopy ( n = 44/222, 20%), inability to reach the patient ( n = 42/222, 19%), and comorbidities ( n = 17/222, 8%). Other EHR-documented reasons included that patients were no longer part of the health system, had completed FIT in error, or were deceased by the time of review. Some patients had no documented reasons for incomplete follow-up colonoscopy.