The COMPLETE-CRC screening initiative: Increasing colonoscopy completion after positive stool-based colorectal cancer screening.

Abstract

e23288 Background: Timely completion of colonoscopy after a positive colorectal cancer (CRC) screening test is essential to reduce CRC-related morbidity and mortality. Despite increased use of stool-based tests (SBTs), real-world follow-up colonoscopy rates remain suboptimal. Methods: This is a quality improvement study of patients aged 45–75 years with a positive SBT between 8/1/2023 and 8/1/2024 within the Cleveland Clinic health system. Eligible patients were identified using an internally validated natural language processing algorithm. Patients without colonoscopy within 360 days were contacted by a patient navigator via phone and MyChart to provide education, facilitate scheduling, and document barriers. Multivariable logistic regression identified factors associated with colonoscopy completion following outreach. Results: Among 2,548 patients with a positive SBT, 803 (31.5%) had not completed diagnostic colonoscopy within 360 days. Of 737 patients eligible for outreach, 456 were successfully contacted. Among contacted patients, 33 completed colonoscopy and 26 scheduled procedures. Reported barriers included limited knowledge or awareness (31.9%), transportation challenges (31.9%), prior negative experiences (10.6%), fear or anxiety (8.5%), cost concerns (4.3%), and communication failures (6.4%). On univariable analysis, increasing age was associated with lower odds of colonoscopy completion (OR 0.94, 95% CI 0.90–0.98; p=0.003). In multivariable analysis adjusted for age, contacted patients had significantly higher odds of colonoscopy completion than those not contacted (OR 4.99, 95% CI 1.95–16.9; p<0.001). Conclusions: Patient outreach was associated with higher odds of colonoscopy completion after a positive SBT, while increasing age was associated with lower completion rates. Overall completion remained suboptimal, underscoring the need for earlier follow-up strategies. Univariate logistic regression of colonoscopy completion. Characteristic N OR 95% CI p-value Outreach Status 737 Not contacted — — Contacted 5.40 2.12, 18.3 0.002 Age 737 0.94 0.90, 0.98 0.003 Sex 737 Female — — Male 1.14 0.58, 2.21 0.7 Race 737 White — — Black 0.63 0.10, 2.15 0.5 Others 1.80 0.42, 5.40 0.4 Unknown/Declined 0.53 0.03, 2.59 0.5 Ethnicity 737 Hispanic — — Not Hispanic 0.79 0.27, 3.36 0.7 Unknown/Declined 0.92 0.16, 5.19 >0.9 Smoking History 737 Never — — Former 0.45 0.18, 1.00 0.060 Current 1.09 0.06, 5.94 >0.9 Unavailable 0.50 0.19, 1.15 0.12 Mychart Status 737 Activated — — Inactivated 0.39 0.11, 1.00 0.079 Unavailable/Declined 0.90 0.05, 4.56 >0.9 ADI Quartile 737 Q1 — — Q2 0.71 0.28, 1.77 0.5 Q3 0.40 0.12, 1.12 0.093 Q4 1.02 0.44, 2.41 >0.9 Unknown 0.00 >0.9 Medical Coverage 737 Commercial — — Medicaid 0.68 0.11, 2.36 0.6 Medicare 0.39 0.11, 1.00 0.079 Unavailable 1.81 0.41, 5.54 0.4 CCI Score 737 0 — — 1 or 2 0.94 0.42, 2.04 0.9 >=3 1.30 0.56, 2.89 0.5