Evaluating the Effectiveness and Economic Viability of a Novel Population-Based Colorectal Cancer Screening Strategy

Background: Colorectal cancer (CRC) remains the second leading cause of cancer-related deaths in the United States, with disparities in screening disproportionately affecting socioeconomically disadvantaged and underrepresented populations, particularly in urban areas. Previous research has shown that proactive outreach strategies such as Fecal Immunochemical Test(s) (FIT) and colonoscopy significantly enhance CRC screening although these efforts typically have targeted patients already engaged with primary care and exclude those without recent primary care visits in the past year. The ACCESS (Advancing Colorectal Cancer Equity through Systematic Screening) initiative, offers a unique and financially sustainable method to address discrepancies in CRC screening. Objective: To evaluate the effectiveness and financial sustainability of the ACCESS initiative, a community-based approach launched by Temple University Hospital (TUH) in Philadelphia, Pennsylvania, which targets CRC screening disparities by circumventing the primary care health system and distributing FIT directly to patients. Methods: The ACCESS program distributed FIT in non-traditional, high-traffic community settings to average risk individuals aged 45-75, per United States Preventive Services and Task Force (USPSTF) guidelines. This method circumvents traditional healthcare touchpoints, such as primary care referrals, reaching those who typically lack regular healthcare engagement. Results: Among the 799 FIT distributed, 293 results were reported (response rate: 36.7%), with 48 positive FIT (positivity rate: 16.4%). Notably, individuals who had not visited a primary care provider in the past year exhibited a higher positivity rate (26.5%) compared to those who had (15.1%) (p=.064). More interestingly, men who saw a primary care doctor within the past year had a positivity rate of 16.0% compared to a 41.4% positivity rate amongst men who did not see a primary care doctor within the past year (p=.056). Follow-up colonoscopy was completed in 29.2% of cases with positive FIT results at Temple University Hospital while the other individuals chose to follow up outside of the Temple Health system. Financial analysis revealed that the majority of follow-up colonoscopies were charged using diagnostic current procedural terminology (CPT) codes as opposed screening CPT codes and that the average reimbursement per CPT charged to a FIT-prompted colonoscopy to be $1,171.62 compared to $1084.60 for non-FIT test prompted colonoscopies. Conclusion: The ACCESS initiative successfully extends CRC screening to underserved populations not previously outlined in other literature describing population-based CRC screening efforts. This initiative demonstrated higher positivity rates among those less engaged in traditional primary care systems and offers insight into the financial sustainability of population-based screening initiatives.