QIM22-190: Virtual Patient Navigation: A Revised Navigation Strategy Proves Successful at Completing CRC Screening in Vulnerable Populations

The COVID-19 shutdown halted elective procedures and limited in-person meetings, causing the Colorectal Cancer Prevention Network (CCPN) screening program to cease for 3 months. During this time, the CCPN focused on developing virtual patient navigation (VPN) to continue its mission of providing colorectal cancer (CRC) screening to uninsured, medically underserved patients despite pandemic-related barriers. CCPN leaders worked with its patient navigators to develop new processes that would facilitate the completion of Fecal Immunochemical testing (FIT) without requiring an in-person clinic visit. After thorough analysis of other patient navigation models for FIT screening completion, the CCPN implemented a VPN visit. HIPAA-compliant video conferencing and phone calls allowed patients to speak with their navigators in a setting designed to maintain the privacy of their medical encounter. The CCPN also developed short how-to videos for patients to watch prior to completing their FIT. Mailed FIT used prepaid stamped envelopes and mail tracking to document delivery, receipt, and return of FIT. A follow-up call relayed FIT results. The team also worked with Gastroenterology partners to develop a COVID-19 screening questionnaire; this was used to ensure safety once colonoscopy procedures were reinstated at local hospitals/endoscopy centers. At the height of the shutdown (April-May 2020), CCPN issued 2 FITs (vs 57 issued during the same period in 2019), a 96% reduction in FITs issued. No colonoscopies were performed (as compared to 81 in April-May 2019). Overall, fewer CRC screenings were conducted (680 in 2020 vs 737 in 2019). Using VPN, we navigated and distributed FIT kits to 731 patients in July 2020-June 2021 (FY2021); of those, 563 tests were completed (77% FIT return rate). FIT+ screens totaled 13.85% (78/563); 35/78 FIT+ patients completed colonoscopies (45% CRC screening completion rate). In total, VPN facilitated completion of 896 screenings in FY2021 (563 FITs, 333 colos). Our data suggests that virtual patient navigation was effective in screening minorities and the underserved for CRC, even during the pandemic. This strategy allowed CCPN to complete more CRC screenings than the in-person navigation, exceeding the number of CRC screenings pre-COVID. We will implement this strategy moving forward with the hopes of expanding our reach and continuing to address healthcare disparities by increasing CRC screening in our state’s vulnerable populations.