Modernizing Colorectal Cancer Screening with Cologuard

From the 2021 HVPAA National Conference

Alaynna Kears (Valley Health Partners – formerly Lehigh Valley Physicians Practice), Arjan Ahluwalia, Maria Jones

Background

Resident clinics typically provide comprehensive health care services to medically underserved communities, many of which experience low colorectal cancer (CRC) screening completion rates. CRC is the second leading cause of cancer deaths in the United States making early detection key for patient survival.

Endoscopic evaluation remains the gold standard for evaluation and allows for direct visualization and real-time assessment. However, the process is fraught with logistical changes, costs, and time commitment. We propose implementation of Cologuard to lessen these costs and ultimately improve CRC screening.

Objective

To improve CRC screening in patients at our Internal Medicine resident clinic to a goal of 60% or higher.

Methods

An electronic medical record report was generated and identified 1,130 patients who were currently overdue for CRC screening at our clinic. Each patient’s chart was individually reviewed and assessed for type of insurance, risk for colorectal cancer, and previous outreach attempts in regard to screening. A list was compiled of patients with Medicare insurance or certain private insurances who were average risk for CRC screening and an order for Cologuard was placed. Each Cologuard order was accompanied by a detailed letter that was sent to the patient explaining that they were due for CRC screening and that a Cologuard test had been ordered on their behalf for them to complete. A total of 283 Cologuard tests were ordered for the qualified patients.

Results

Of the 283 patients for which a Cologuard order had been placed, 67 patients (24%) completed the test kit after 2 months. Of the 67 patients who completed the test, 13 patients (19%) had a positive result, 44 patients (66%) had a negative result, and 10 patients (15%) had an inadequate sample that could not be processed. The overall CRC screening rate at our clinic improved from 56.4% to 61% in just over two months by supplementing our current CRC screening methods with Cologuard.

Conclusions

Utilization of Cologuard testing improved our CRC screening rates to above our goal of 60%.

Clinical Implications

The Covid-19 pandemic has created new stresses on the healthcare system, and this is illustrated in the significant delay in scheduling colonoscopies. Furthermore, our patient population already consists of a large percentage of patients who decline endoscopic evaluation secondary to cost, transportation issues, low health literacy, and intolerance of bowel prep. We proposed providing our patients with the option of Cologuard testing that could be completed in the convenience of their homes without Covid-19 risks. Additionally, our chart review ensured that this was covered by their insurance and hence they did not incur any out-of-pocket costs.

Patients with positive Cologuard tests were promptly referred for colonoscopy and are in the process of being evaluated endoscopically. Efforts will continue to take place in performing CRC screening for our remaining patients who did not qualify for Cologuard and those patients who have yet to complete their Cologuard test.