Epidemiology of Colorectal Cancer Screening Completers and Non-Completers at an Urban Primary Care Practice

Background
Colorectal cancer is the second leading cause of cancer-related deaths in men and women in the United States. In an urban multi-clinic primary care practice, we want to conduct interventions to target non-completers of colorectal cancer (CRC) screening. We will evaluate the percentage of patients who are up to date on their CRC screening and compare characteristics between completers and non-completers to design interventions that engage non-completers in preventive health screening.

Methods
We conducted a cross-sectional study using Epic-generated patient reports in January 2020 in an urban primary care practice. It consists of 5 different practices set in various socioeconomic neighborhoods in NYC, including two HIV primary care practices. Completion of CRC screening is defined as satisfying USPSTF guidelines for CRC screening. We evaluated the following characteristics between completers vs non-completers of CRC screening: age groups (every 5 years), sex, zip code, hierarchical condition categories (HCC) score, presence of value-based insurance coverage, method of CRC screening, and presence of PCP visit within the last 1 year or 3 years. We used the frequency and univariate functions in SAS 9.4 to analyze the data.

Conclusions
Our needs assessment reveals that the overall CRC screening rate of 53% is below that of the national average at 68%, and much improvement is needed to increase CRC screening rates. These results will help us to target outreach efforts to focus on younger, male, and healthier patients who have not had recent contact with our primary care team. Given the low utilization of stool-based tests, it is an area of opportunity for intervention, especially during the unprecedented COVID pandemic.