1. BACKGROUND RESULTS METHODS
Mailed Fecal Immunochemical Test (FIT) Kits to increase screening uptake in the University of Pennsylvania’s Community Service Area Ndidi Enwereji Chair: Dr. Russell McIntire Preceptor: Rebecca Pepe
BACKGROUND
RESULTS
DISCUSSION & LIMITATIONS
Response rates within the CSA were higher compared to response rates of patients residing outside the CSA (16.6% vs. 12.4%, respectively)
The bivariate analysis showed positive correlation between race and CT-level median income as the main predictors of timely return of FIT kits within 2 months of patients residing in the Philadelphia-Camden-Wilmington Statistical Area in 2016
The odds of returning FIT kits within 2 months were 48.6% lower for African-American patients when compared to Whites
Asians were 66.2% less likely to return their FIT kit within two months when compared to Whites
Patients of Other/Unknown races also had lower response rates (52.4% less likely to return their FIT kit) when compared to Whites
Patients that lived in census tracts with household median incomes earning less than $30,000 and $30,000-$45,000 were 62.8% and 62.1% less likely to return FIT kits within two months, respectively, when compared to patients residing in census tracts with median household incomes earning $100,000 or more
Proximity analysis of patients residing within the CSA:
Patients residing within 2.09 miles of HUP had higher response rates compared to patients residing 4.19 miles from HUP
Response rate of patients residing within 2.09 miles of HUP : 59%
Response rate of patients residing within miles of HUP: 41%
Limitations:
Use of individual and area-level variables
Use of EMR and self-reported data
Need for more rigorous EMR audits
Influence of financial incentives on response rate not analyzed
Colorectal cancer (CRC) is the 2nd leading cause of cancer death
African Americans are particularly affected
Socioeconomic status (SES), gender and age are important factors that influence screening
1 in 3 adults do not comply with CRC screening
Penn’s Community Service Area (CSA):
A majority of families live in poverty (53% )
49% (25 and older) have high school-level education
1 in 4 adults 50 years and older in the service area are non-compliant with CRC
Fecal Immunochemical Test (FIT):
Noninvasive, fecal occult blood test used to detect specific antibody for human hemoglobin
A commonly used modality for CRC screening in average-risk patients
Mailed to patients fitting Colorectal Cancer Screening Outreach (CRCSO) program criteria listed below (Figure 1)
Research Questions:
Does colonoscopy screening by mailed FIT test completion within 2 months vary significantly for patients of the CRCSO pilot program residing within vs outside the CSA?
How does area-level SES correlate with FIT colonoscopy screening adherence within 2 months for patients mailed FIT kits in the pilot program?
Table Binary Logistic Regression of Race and Return of FIT Kit within 2 Months
Table Binary Logistic Regression of Median Income and Return of FIT Kit within 2 Months
METHODS
Population: CRCSO pilot program (eligibility criteria below)
Data source: PennChart and American Census Survey
Outcome: Completion and return of FIT kit within 2mths.
Bivariate analysis using chi-squared statistical test to determine statistically significant variable associated with the return of FIT kits within 2 months
Simple logistic regression model was used to determine the probability of patients returning their FIT kits within 2 months
Proximity analysis:
Geocoded patient address to census tract (CT)
Buffers
Table Binary Logistic Regression of High School Graduation Rate and Return of FIT Kit within 2 Months
CORE COMPETENCIES
Analytic/Assessment Skills
Communication Skills
Cultural Competency Skills
Community Dimensions of Practice Skills (advancing community involvement)
Public Health Sciences Skills (critiquing and developing research)
Leadership and Systems Thinking Skills
Figure Flowchart of program processes & Eligibility Criteria
Eligibility Criteria:
50-75 years old
2 primary family care (PFC) visits in 2 years
Philadelphia-Camden-Wilmington Metropolitan Statistical Area
Average risk for CRC and eligible to receive colonoscopy
Figure Proximity Analysis
ACKNOWLEDGEMENTS
The author would like to thank Dr. McIntire, Dr. McAna and Dr. LaNoue for providing their guidance and expertise towards the completion of this project, as well as Dr. Chyke Doubeni and Rebecca Pepe of Penn Presbyterian Medical Center for providing the data used in this study.