Abstracts

Rebecca Ekeanyanwu, MHS; Brandon C. Smith, MD; Artin Galoosian MD, MA; Jayraan Badiee, MPH; Sitaram Vangala, MS; Sadie De Silva MD; Folasade P. May MD, PhD, MPhil

Introduction: To identify effective population health approaches to increase colorectal cancer (CRC) screening participation in individuals age 45 to 49, our health system implemented and compared four screening outreach strategies. In this secondary analysis, we compared the effectiveness of each strategy by race/ethnicity to inform future screening outreach in our health system, address screening disparities, and improve the overall screening rate. Click here for full abstract

Matthew Y. Zhao, BS; Vidhi Singh, BS; Megan M. Aaronson, MD, MS; Sadie R. De Silva, MD; Hayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: National data suggest that racial and ethnic disparities in colorectal cancer (CRC) screening are decreasing, reflecting success of equity-driven initiatives across the United States. However, there is a paucity of data on CRC screening trends in low-income and underinsured populations such as those at Federally Qualified Health Centers (FQHCs). To evaluate national progress towards equity in this setting, we assessed FQHC CRC screening rates by race/ethnicity. Click here for full abstract

Sadie De Silva, MD; Brandon C. Smith, MD; Sarah Meshkat, MHA; Laurie Smith, MHA, MBA; Christopher Saigal, MD, MPH; Anna Dermenchyan, PhD, RN; Hisae Suekane; Chad Villaflores, BS; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: Population health interventions are needed to increase colorectal cancer (CRC) screening participation. WiserCare is an electronic-based patient decision aid ordered by primary care providers (PCPs) that assesses patient preference and provides individualized risk anaylysis and options for CRC screening modalities. This study is a preliminary analysis of process measures related to the implementation of WiserCare in an academic health center. Click here for full abstract

Jaime Yang, MD; Sadie De Silva, MD; Brandon C. Smith, MD; Camille Soroudi, MD; Anthony Myint, MD; Bita Shahrvini, MD; William Hsu, MD; Cleo Maehara, MD; Jayraan Badiee, MPH; Alexandria Uy; Yuna Kang, MD; Bita Naini, MD; Ventakaraman Muthusamy, MD, MS; Eric Esrailian, MD, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: Post-polypectomy surveillance aims to increase early detection and prevention of colorectal cancer (CRC). High risk neoplasia (HRN), defined as adenoma or sessile serrated polyp (SSP) greater than 1 centimeter, adenoma with tubulovillous or villous histology, highgrade dysplasia, >5 adenomas or SSPs, or traditional serrated adenoma, increase CRC risk and require a 3-year surveillance interval as per the 2020 United States Muti-Society Task Force (MSTF) guidelines. We previously developed and implemented a natural language processing (NLP) algorithm that uses artificial intelligence (AI) to extract data from colonoscopy and pathology reports to determine guideline-concordant surveillance intervals. In this study, we aimed to evaluate the NLP’s false negative rate for 3-year surveillance to help assess its overall performance before broad application in a health system intervention. Click here for full abstract

Brandon C. Smith, MD; Sadie De Silva, MD; Laurie Smith, MPH, MBA; Anna Dermenchyan, PhD, RN; Hisae Suekane; Chad Villaflores, BS; Jayraan Badiee, MPH; Christopher Saigal, MD, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: There are several recommended colorectal cancer (CRC) screening modalities, and patient preference is contingent on factors such as eligibility, invasiveness, time required, and effectiveness. Patients who select a modality aligned with their preferences are more likely to complete screening. We aimed to assess the feasibility of an electronic decision aid to increase CRC screening participation and to inform implementation of a future large-scale decision aid intervention. Click here for full abstract

Anthony Myint, MD; Sonia Divakaran, RN-BC; Jayraan Badi, MPH; Folasade P. May, MD, PhD, MPhil; Kevin Ghassemi, MD

Introduction: Anti-reflux procedures provide an important treatment option for patients with medically refractory gastroesophageal reflux disease (GERD) but are dependent on proper patient selection through pre-procedural testing. We assessed the rates of pre-procedural test completion for patients who completed an anti-reflux procedure in a large academic health system and to determine factors associated with incomplete preprocedural testing. Click here for full abstract

Timothy A. Zaki, MD; Nicole J. Zhang, MPH; Victoria M. Raymond, MS; Nick Ioannou, MD, PhD, MHA; Shaun P. Forbes, PhD; Amar K. Das, MD, PhD; Folasade P. May, MD, PhD, MPhil

Introduction: Blood-based screening tests for colorectal cancer (CRC) are becoming increasingly prevalent and have the potential to improve adherence with screening guidelines and overall CRC outcomes. As for all non-colonoscopic screening tests, abnormal blood-based test results require follow-up colonoscopy (FU-CY) to complete the screening process. We aimed to perform one of the first analyses of FU-CY rates after abnormal blood-based screening test results and determine predictors of follow-up. Click here for full abstract

Sadie De Silva, MD; Marc Kaneshiro, MD; Brandon C. Smith, MD; Jamie Olivia Yang, MD; Michael Bethlehem; Cleo K. Maehara; Alexandria Uy; William Hsu, MD; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: Adenoma detection rate (ADR) is correlated with low risk of interval colorectal cancer (CRC) and reflects the overall effectiveness of screening colonoscopy. Accurate provider perception of performance can enhance quality efforts while inaccurate perception can hinder progress. We aimed to examine the perception of gastroenterologists (GIs) on ADR in a large academic health system. Click here for full abstract

Nguyen V. Pham; Mei Leng; Steven-THuy Han, MD; Folasade P. May, MD, PhD, MPhil; Jihane N, Benhammou, MD, PhD

Introduction: Hepatocellular carcinoma (HCC) is increasing in prevalence among Veterans. We have shown that Vietnam Veterans who self-identified as Hispanic and non-Hispanic Black were more likely to develop HCC, compared to non-Hispanic White Veterans. Identifying clinical and social determinants of health (SDOH) associated with HCC disparities has the potential to improve detection and treatment of HCC in vulnerable Veterans. Click here for full abstract

Rebecca Ekeanyanwu, MHS; Jayraan Badiee, MPH; Sitaram Vangala, MS; Brandon C. Smith, MD; Artin Galoosian MD, MA; Folasade P. May MD, PhD, MPhil

Introduction: In 2022, our health system conducted a randomized controlled trial to compare four screening outreach approaches for average-risk individuals age 45 to 49. In this follow-up survey, we aimed to determine the factors that influence decision-making and screening practices of young adults at average-risk for CRC and newly eligible for screening. Click here for full abstract

Vidhi Singh, MD; Matthew Y. Zhao, BS; Megan A. Aaronson, MD, MS; Jayraan Badiee, MPH; Folasade P. May MD, PhD, MPhil

Introduction: Federally Qualified Health Centers (FQHC) offer preventive health services, including colorectal cancer (CRC) screening, to low-income and under-insured individuals in the United States (U.S.). Some FQHCs utilize health information technologies (HIT) such as kiosks, patient portals, and automated preventive care outreach to improve patient engagement and collect social risk factor (SRF) data. We aimed to determine the relationship between the use of HIT for this purpose and CRC screening rates in FQHCs. Click here for full abstract

Jessica J. Tuan, MPH; Adjoa Anyane-Yeboa MD MPH; Erica T. Warner, ScD, MPH; Yixuan Zhou; Suzanne Brodney, PhD, MS; Andrew T. Chan, MD, MPH; David A. Drew, PhD; Beth Glenn, PhD; Ellen T. Lee, BS; Nicolette J. Rodriguez, MD, MPH; Kimberly Schoolcraft; Sapna Syngal, MD, MPH; Jennifer S. Haas, MD MSc; Folasade P. May, MD, PhD, MPhil

Introduction: Colorectal cancer (CRC) screening is underutilized, especially in community health centers (CHCs) that provide primary care services to low-income, uninsured, and racial/ethnic minority populations. The Community Collaboration to Advance Racial/Ethnic Equity in CRC Screening (CARES) study aims to increase CRC screening rates in CHCs in three regions of the United States. In this pre-intervention analysis, we aimed to evaluate baseline CRC screening rates and CHC characteristics in FQHCs in two of the study regions. Click here for full abstract

Amarachi Erondu, MD; Folasade P. May, MD, PhD, MPhil; Jenny S. Sauk, MD; Nirupama N. Bonthala, MD; Berkeley N. Limketkai, MD, PhD

Introduction: Patients with inflammatory bowel disease (IBD) have an increased risk of contracting infections that are preventable by vaccines. According to clinical guidelines, patients with IBD should receive the flu vaccination yearly. In this study, we used nationwide data from the United States National Health Interview Survey to determine demographic and socio-economic factors associated with flu vaccination in patients with IBD. Click here for full abstract

Megan R. McLeod, MD, MSCR; Jessica Tuan, MPH; Beth A. Glenn, PhD; Alison K. Herrmann, PhD, MS; Analissa Avila, MS; Debra Rosen, RN, MPH; Catherine M. Crespi, PhD; Narissa Nonzee, PhD; Christine Park, MD, MPH, CLE, FAAP; Alicia Lwin, MD; Joanna Quintanilla, CHES, CLE; Roshan Bastani, PhD; Folasade P. May, MD, PhD, MPhil

Introduction: The fecal immunochemical test (FIT) is an affordable and effective colorectal cancer screening method if completed annually and if individuals with an abnormal result undergo timely follow-up colonoscopy. This process is challenging in Federally Qualified Health Centers (FQHCs), where millions of low-income patients receive primary care services, and where follow-up colonoscopy requires referral to outside providers. We aimed to determine the critical clinical steps between abnormal FIT and colonoscopy and to calculate attrition rates at each of these steps in one of the largest FQHCs in the United States. Click here for full abstract

Matthew Y. Zhao, BS; Yvonne Y. Lei, BS; Megan R. McLeod, MD, MSCR; Jayraan Badiee, MPH; Artin Galoosian, MD, MS; Folasade P. May, MD, PhD, MPhil

Introduction: Federally Qualified Health Centers (FQHCs) offer preventive health services, including colorectal cancer (CRC) screening, for low-income and under-insured individuals in the United States (U.S.). CRC screening rates in FQHCs increased from 2014 to 2019 but declined in 2020, coinciding with the beginning of the COVID-19 pandemic. We assessed changes in CRC screening rates and clinic-level factors associated with changes in screening rates from 2020 to 2021 in U.S. FQHCs. Click here for full abstract

Artin Galoosian MD, MS; Daniel Croymans MD, MBA; Hengchen Dai PhD; Silvia Saccardo PhD; Craig R. Fox, PhD; Gregory Goshgarian, MD; Sadie De Silva, MD; Maria A. Han, MD; Sitaram Vangala, MS; Folasade P. May, MD, PhD, MPhil

Introduction: Colorectal cancer (CRC) incidence and mortality have increased in young adults in the United States, prompting several new guidelines that promote screening individuals starting at age 45. Effective population health strategies to screen these individuals have not yet been established. Thus, we aimed to determine effective outreach strategies to maximize screening participation among patients aged 45-49 in a diverse health system. Click here for full abstract

Aileen Bui, MD; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths in the United States (US) and has rising incidence and mortality. HCC disproportionately impacts low-income and racial/ethnic minority populations. These disparities are multifactorial; however, the impact of timely treatment on HCC disparities is understudied. We aimed to examine the impact of race/ethnicity, socioeconomic status (SES), and time to treatment on mortality in individuals age ≥18 with HCC. Click here for full abstract

Claire E. Kim, PhD, MPH; Carra Simpson, PhD; Folasade P. May, MD, PhD, MPhil; Jamie O. Yang, MD; Jonathan P. Jacobs, MD, PhD; Marc C. Kaneshiro, MD; Terri E. Getzug, MD; Karin B. Michels, ScD, PhD

Introduction: Colorectal cancer (CRC) is the fourth most diagnosed cancer and second most common cause of cancer-related deaths among men and women in the United States. Recent experimental evidence has suggested a potential role for the gut microbiome in CRC pathogenesis. Prebiotic supplements have been observed to affect gut microbial diversity in animal and human studies, suggesting a chemopreventive effect on colorectal neoplasia. The present study aims to investigate whether soluble dietary fiber, xylooligosaccharides (XOS), enhances the re-establishment of the gut microbiome composition following exposure to prescription laxatives. Click here for full abstract

Yvonne Lei, BA; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: Food insecurity (FI) has been associated with low access to healthcare services, poor health outcomes, and health disparities. However, little is known about the relationship between FI and colorectal cancer (CRC) screening and outcomes. Thus, we aimed to examine the association between FI and utilization of CRC screening in the United States. Click here for full abstract

Shailavi Jain, MD; Artin Galoosian, MD, MS; Jayraan Badiee, MPH; Sarah Meshkat, MHA; Folasade P. May, MD, PhD, MPhil

Introduction: Family history of colorectal cancer (CRC) is a risk factor for CRC and contributes to one-third of cases in the United States. Health system interventions to increase CRC screening often exclude these high-risk individuals, and few interventions that increase screening participation in this population have been published. We designed, implemented, and evaluated the impact of a multicomponent health system intervention designed to increase CRC screening uptake among individuals with a documented family history of CRC. Click here for full abstract

Megan R. McLeod, MD, MSCR; Matthew Y. Zhao, BS; Yvonne Lei, BS; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: Medicaid expansion is a provision in the Affordable Care Act that increases access to health insurance and preventive services for low-income individuals, however not all U.S. states participate. Individuals with Medicaid and in medically underserved areas often receive preventive services at Federally Qualified Health Centers (FQHCs). We aimed to study the impact of Medicaid expansion on colorectal cancer (CRC) screening rates in FQHCs by comparing CRC screening rates and predictors of screening in FQHCs in Medicaid expansion and non-expansion states. Click here for full abstract

Jaime O. Yang, MD; Sadie De Silva, MD; Cleo Maehara, MD; Alexandria Uy; Emma Kate Peterson; Artin Galoosian, MD, MS; Camille Soroudi, MD; Anthony Myint, MD; William Hsu, PhD; Yuna Kang, MD; Bita V. Naini, MD; V. Raman Muthusamy, MD, MS; Eric Esrailian, MD, MPH; Folasade P. May, MD, PhD, MPhil

Click here for full abstract

Shailavi Jain, MD; Sarah Meshkat, MHA; Folasade P. May, MD, PhD, MPhil

Introduction: There is increasing attention in health systems to implement interventions that increase patient participation in colorectal cancer (CRC) screening. Our large academic health system has a well-established biannual mailed fecal immunohistochemical test (FIT) outreach program that mails FIT kits to average-risk patients overdue for CRC screening. This program, and many similar programs nationally, exclude patients without an attributed primary care physician (PCP) due to lack of a provider to act on abnormal results. Nationally, many programs struggle to develop a PCP attribution model that accurately excludes patients without an active PCP. We aimed to assess the accuracy of the PCP attribution model developed in our health system for our mailed FIT outreach program with the goal to optimize attribution for future mailing cycles. Click here for full abstract

Megan R. McLeod, MD, MSCR; Jessica Tuan, MPH; Beth A. Glenn, PhD; Alison K. Herrmann, PhD, MS; Analissa Avila, MS; Debra Rosen, RN, MPH; Catherine M. Crespi, PhD; Narissa Nonzee, PhD; Christine Park, MD, MPH, CLE, FAAP; Alicia Lwin, MD; Joanna Quintanilla, CHES, CLE; Roshan Bastani, PhD; Folasade P. May, MD, PhD, MPhil

Introduction: Fecal immunochemical test (FIT) effectiveness for colorectal cancer (CRC) prevention and early detection is contingent on timely colonoscopy after abnormal results. Receipt of follow-up colonoscopy is low in safety-net settings, including Federally Qualified Health Centers (FQHCs), which provide primary care services to 30 million Americans annually. We aimed to determine patient factors associated with receipt of, and time to, follow-up colonoscopy in one of the largest FQHCs in California. Click here for full abstract

Camille Soroudi, MD; Sadie De Silva, MD; Emma Kate Peterson; Cleo Kaiaki Maehara, MD; Jayraan Badiee, MPH; Anthony Myint, MD; V. Raman Muthusamy, MD, MS; Eric Esrailian, MD, MPH; William Hsu, PhD; Folasade P. May, MD, PhD, MPhil

Introduction: Accurate determination and documentation of post-polypectomy surveillance intervals for screening colonoscopy is essential to reduce colorectal cancer (CRC) incidence and mortality. It is particularly important to ensure timely surveillance for patients with high-risk polyps that warrant 3-year follow-up. In order to improve guideline-concordant surveillance after screening colonoscopy, we sought to validate a previously developed natural language processing (NLP) algorithm that automates determination of post-polypectomy colonoscopy surveillance intervals. Click here for full abstract

Adjoa Anyane-Yeboa, MD, MPH; Jennifer Haas, MD, MSc; Roopa Bhat, BS; Suzanne Brodney, PhD; Yuchiao Chang, PhD; Folasade P. May, MD, PhD, MPhil

Introduction: Incidence of colorectal cancer (CRC) has been increasing in individuals age < 50 years for the past several decades. This rising incidence prompted the United States Preventive Services Task Force to revise their CRC screening recommendations in May 2021 to include screening individuals age 45 to 49. With this guideline change, there was a sudden increase in the number of screening-eligible individuals. As this younger population is more racially/ethnically diverse than the older population in the US, the sociodemographic characteristics of this “new to CRC screening” population may require different outreach and education. The objective of our study is to evaluate the impact of the updated screening guidelines on screening rates and the characteristics of the unscreened population in a large health system. Click here for full abstract

Aileen Bui, MD; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: Hepatocellular carcinoma (HCC) is a major complication in patients with cirrhosis and a leading cause of cancer-related deaths in the United States (US). Delays in initiation of treatment are associated with poor HCC outcomes; however, factors that predict time to treatment are underexplored. We aimed to examine differences in time to treatment by race, ethnicity, and socioeconomic status (SES) in adults with HCC. Click here for full abstract

Oliva J. Jordan, MD; Jiwen Li, MD; Anjani Reddy, MD, MPH; Amit Kothari, MD; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: The fecal immunochemical test (FIT) is effective in reducing colorectal cancer (CRC) incidence and mortality. In many Veterans Health Administration (VA) facilities, FIT is the preferred method for CRC screening for average-risk individuals. However, a challenge with FIT screening is that an abnormal test must be followed by colonoscopy. Effective interventions to increase colonoscopic completion after abnormal FIT are lacking. We implemented and assessed the impact of an automated reminder call to patients with an abnormal FIT result on colonoscopy completion in a Veteran population. Click here for full abstract

Shailavi Jain, MD; Sarah Meshkat, MHA; Folasade P. May, MD, PhD, MPhil

Introduction: Colorectal cancer (CRC) remains common and deadly despite national screening guidelines and multiple screening modalities. Screening rates declined during the COVID-19 pandemic, and the pandemic impacted health system CRC screening interventions, including mailed fecal immunochemical test (FIT) outreach. We aimed to evaluate trends in response rates to mailed FIT outreach in our health system before, during, and after the COVID-19 pandemic. Click here for full abstract

Sadie De Silvia, MD; Jordan Olivia, MD; Amarachi Erondu, MD; Sarah Meshkat, MBA; Shelly J. Dumaguindin; Juyea Hoo; Sean H. Furling; Anna Dermenchyan, MSN, RN, CCRN-K; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: The measurement of colorectal cancer (CRC) screening rates is imperative for quality reporting and population health management. Tracking screening rates is difficult in real-time and complicated by changes in clinical guidelines, clinical practice, and other regional and national events. We developed and validated a clinical dashboard that tracks real-time population health CRC screening data in a large health system. Click here for full abstract