Reminder of my intervention: the GIFFy study aims to implement gastroenterology-based follow-up of positive fecal immunochemical tests (FIT), with creation of standardized best practices, uniform goal-setting, and creation of a designated nurse-navigator position in each GI facility.
Target population: Patients with positive FIT in organized colorectal cancer screening programs, and the health systems that provide care for them.
Study population: Patients with positive FIT in Kaiser Permanente Northern California (KPNC), the primary care and gastroenterology providers who care for them, and the organizers of the screening outreach program.
Differences:
- KPNC is an integrated health system, meaning that all of their providers have access to the same electronic health record to track test-positive patients and primary care offices refer all of their test-positive patients to one gastroenterology facility, and GI facilities get all of their referrals from a limited number of medical offices. This facilitates communication and allows for interventions that shift tasks and responsibilities between the two departments. While this is true in an increasing number of health systems, it is certainly not the norm in the US.
- KPNC gastroenterology facilities can create their own ‘e-referrals’ for FIT-positive patients, which facilitates them taking responsibility for these patients.
- In most of the US, incentives are in place to increase CRC screening rates, but not the appropriate follow-up of positive tests. KPNC has been able to create a ‘performance-based allocation’ that rewards rapid colonoscopy access after positive FIT. Some facilities are already using these funds to pay a designated nurse navigator. Many GI facilities outside of KPNC would have trouble funding this type of job.
Similarities:
The KPNC patient population is diverse and has been shown to closely mirror the underlying census population of Northern California.