Date of Graduation

Summer 8-10-2018

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Healthcare Systems Leadership DNP

First Advisor

Dr. Juli Maxworthy

Second Advisor

Dr. Nancy Selix

Abstract

Each year, eligible veterans are referred to the gastroenterology department for colorectal cancer screening, primarily for colonoscopy. Once the colonoscopy is completed and is found to be unremarkable, the patient is asked to return in 10 years for a follow-up colonoscopy. However, if problems are found on the original colonoscopy, such as polyps, the patient enters a surveillance period where more frequent colonoscopy monitoring occurs. While primary care providers are aware of the monitoring guidelines, many providers unnecessarily order fecal immunochemical tests (FITs) during this period of surveillance. Unnecessary costs to the Veterans Affairs Health System (VAHS) include cost of the kit, time for the provider to order the test, technician time to run the test, patient mailing costs to send the kit to the patient, patient time and expense to return the kit, and time interpreting and reporting the results, which ultimately do not change the course of treatment. This project assessed retroactive VAHS data on appropriate utilization of the FIT. Results showed that within the Veteran Affairs Sacramento system, inappropriate FIT utilization existed. Interventions, such as annual colorectal cancer symposiums and ongoing training as part of educational efforts to increase knowledge of guidelines, were implemented. Post-intervention data indicated the effectiveness of interventions through an 8% decrease in the rate of inappropriate FIT ordering. Ensuring appropriate utilization of the FIT improves standardization of care and decreases health care costs.

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