Journal of Community Health

, Volume 42, Issue 3, pp 551–557 | Cite as

The Need for an Integrated Patient Navigation Pathway to Improve Access to Colonoscopy After Positive Fecal Immunochemical Testing: A Safety-Net Hospital Experience

  • Sreedevi Thamarasseril
  • Taft Bhuket
  • Chuck Chan
  • Benny Liu
  • Robert J. WongEmail author
Original Paper


Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the United States. Delays in access to colonoscopy following positive fecal immunochemical test (FIT) contribute to increased CRC incidence and mortality. To evaluate intervals from positive FIT result to receipt of colonoscopy among underserved safety-net populations. We retrospectively evaluated all average CRC risk adults who had positive FIT results from 2012 to 2015 at an ethnically diverse safety-net hospital system. Interval from positive FIT to receipt of colonoscopy was evaluated with Kaplan Meier methods and multivariate Cox proportional hazards models. Among 467 patients with positive FIT (48.4 % men, 39.5 % black, 22.5 % white, 17.4 % Asian, 9.7 % Hispanic, mean age 59.5 ± 9.8 years), mean time from positive FIT to receipt of colonoscopy was 220.5 days (SD 158.5). Compared to men, there was a trend towards longer time from FIT positive to colonoscopy among women (237.1 vs. 198.7 days, p = 0.07). No race/ethnicity-specific disparities in time to colonoscopy were observed. Compared to 2012–2013, there was a 27.2 % reduction in time from FIT positive to colonoscopy in 2014–2015 (173.9 vs. 238.8 days, p < 0.01). Among patients undergoing colonoscopy, 46.3 % had adenomatous polyps, 27.4 % had high risk adenomatous polyps, and 5.6 % had CRC. Among an ethnically diverse safety-net hospital system, improvements in access to colonoscopy after positive FIT were observed. However, patients still waited nearly 6 months from time of positive FIT to undergoing colonoscopy. Delays in receipt of colonoscopy are complex and reflect system-level and individual patient-level barriers.


Access to care Colonoscopy Colon cancer Screening Safety-net 


Compliance with Ethical Standards

Conflict of Interest

The authors of this manuscript have no conflicts of interest to disclose.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sreedevi Thamarasseril
    • 1
  • Taft Bhuket
    • 1
  • Chuck Chan
    • 1
  • Benny Liu
    • 1
  • Robert J. Wong
    • 1
    Email author
  1. 1.Department of Medicine, Division of Gastroenterology and HepatologyAlameda Health System – Highland HospitalOaklandUSA

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