A Clinic-wide Intervention (Primary Care-GI Connect) for Improving Rates of Colonoscopy After Abnormal Fecal Immunochemical Test Result in Patients at Federally Qualified Health Centers

Evaluated in patients with an abnormal fecal immunochemical test (FIT) result using electronic health record data. Will use a difference-in-differences approach, assessing whether change in completion rates from baseline to the implementation period differs between the intervention and usual care conditions, thus accounting for potential differences among clinics pre-implementation. Will fit a mixed effects logistic regression model with a dependent variable of patient-level colonoscopy completion within 6 months (yes/no).

The Investigators will measure the percent of cases for which the FIT tracker is used, as well as its use for each step in the process. For these measures, we will also measure time to completion.

The Investigators will measure both the percent of patients who are notified of their abnormal results as well as the time to notification.

The Investigators will measure the percent of patients who receive a referral.

The Investigators will measure the time to patient referral.

The Investigators will measure the percent completion of interventions for patients at each step.

The Investigators will measure the time to completion of interventions.

The Investigators will measure the percent of cases in which patient education is delivered.

The Investigators will measure the time to delivery of patient education when it is offered.

The Investigators will measure the percent of patients who complete a pre-colonoscopy visit.

The Investigators will measure the time to completion of a pre-colonoscopy visit.

The Investigators will measure the percent of patients for which colonoscopy and pathology results are received at NEVHC.

The Investigators will measure the time to retrieval of colonoscopy and pathology results received at NEVHC.

Will use standard cost-effectiveness techniques (including time discounting) to conduct an incremental cost-effectiveness analysis, measuring the Incremental Cost-Effectiveness Ratio of the usual care and Primary-care GI connect intervention conditions.

The Investigators will use a difference-in-differences approach, assessing whether change in completion rates from baseline to the implementation period differs between the intervention and usual care conditions, thus accounting for potential differences among clinics pre-implementation. Will fit a mixed effects logistic regression model with a dependent variable of patient-level colonoscopy completion.

Evaluated in patients with an abnormal FIT result using electronic health record data. Will use a difference-in-differences approach, assessing whether change in completion rates from baseline to the implementation period differs between the intervention and usual care conditions, thus accounting for potential differences among clinics pre-implementation. Will fit a mixed effects logistic regression model with a dependent variable of patient-level colonoscopy completion within 9 months (yes/no).

The Investigators will use the Organizational Readiness to Implement Change tool to measure responses from clinic stakeholders at each site. This is a standardized tool.

In qualitative interviews with stakeholders and on standardized forms, we will learn about major challenges to implementation across clinics and over time. These will be qualitative data.

In qualitative interviews with stakeholders, we will learn whether there were any changes we need to be intended intervention components.

The Investigators will use EHR data to measure clinic size, location, staffing, resources, number of providers, number of patients to evaluate associations with successful intervention implementation.