ABSTRACT

Colorectal cancer (CRC) screening rates remain below national benchmarks, particularly among communities of color. Fecal immunochemical tests (FIT) are an evidence-based, cost-effective, at-home CRC screening method. This quality improvement project was conducted at a federally qualified health center (FQHC) in southwest Chicago, where 90.5% of patients speak only Spanish. The project objective is to reduce screening disparities and increase CRC screening rates through a mailed FIT outreach program. The intervention included staff education, introductory letters, mailed FIT kits with post mail tracking, bilingual materials, text message reminders, provider follow-up on abnormal results, and a gift card incentive. The Six Sigma framework guided implementation; data was collected from REDCap, internal and public databases. This project was funded by the American Cancer Society (ACS).
A total of 100 FIT kits were mailed, and 16% were returned. The overall positivity rate was 12.5%. All patients who tested positive had provider follow-up. Medical assistant knowledge increased following the intervention, however there was no statistically significant difference between pre- and post-survey scores (p = 0.79).
Recommendations include increasing staff engagement through live phone call reminders, motivational interviewing by providers, and MyChart portal reminders. Gift cards may have incentivized patients who planned to screen but did not impact their screening decision. This project was used as an argument for investing in Cologuard, which was introduced to the Chicago FQHC in March 2025.