Abstracts

Carrie R. Wong, MD, PhD; Analissa Avila, MS; Yvonne N. Flores, PhD; Folasade P. May, MD, PhD, MPhil; Beth Glenn, PhD; Roshan Bastani, PhD

Introduction: The Fibrosis-4 (FIB-4) score is widely used to stratify risk of advanced fibrosis and is most appropriately used in low-prevalence primary care settings. The FIB-4 score can be reassessed within 3 years depending on the patient’s metabolic risk factors. However, recent studies have suggested limitations in FIB-4 score accuracy even in nonspecialty settings. We aimed to identify the association of clinicodemographic variables and risk of incident cirrhosis by FIB-4 score in a large primary care cohort. Click here for full abstract

Vidhi Singh, BS; Matthew Y. Zhou, MD; Helen Xu, MD; Megan R.M. Aaronson, MD, MS; Jayraan Badiee, MPH; Folasade P. May, MD, PhD, MPhil

Introduction: LGBTQIA+ adults in the United States (US) often face unique barriers to health care services that are augmented by intersecting marginalized identities. LGBTQIA+ patients receiving preventive services at Federally Qualified Health Centers (FQHCs) represent a particularly underserved and understudied population. We assessed colorectal cancer (CRC) screening rates and predictors of screening in US FQHCs serving primarily LGBTQIA+ adults compared to FQHCs serving primarily cisgender-heterosexual (cishet) adults. Click here for full abstract

Folasade P. May, MD, PhD, MPhil; Jessica J. Tuan, MPH; Suzanne Brodney, PhD, MS; Beth Glenn, PhD; Yixuan Zhou; Adjoa Anyane-Yeboa, MD, MPH; Nicolette J. Rodriguez, MD, MPH; Caylin Marotta, MPH; Susan Regan, PhD; Sapna Syngal, MD, MPH; Andrew T. Chan, MD, MPH; Catherine Jeffries; Kelley Le Beaux, MA; Samantha Kuney, MA; Kimberly Schoolcraft; Anjelica Q. Davis, MPPA; Chinedu Ukaegbu, MBBS, MPH; Erica T. Warner, ScD, MPH; Beverly Moy, MD, MPH; David A. Drew, PhD; Gina Johnson; Yuchiao Chang, PhD; Jennifer S. Haas, MD, MSc

Introduction: Community health centers (CHCs) in the United States (US) provide primary care services to over 31 million low-income and uninsured individuals. In CHCs, stool-based colorectal cancer (CRC) screening modalities are common; however, screening rates and colonoscopic follow-up after abnormal screening are below the national average. This 2-arm pragmatic trial aims to increase CRC screening and follow-up after abnormal screening in CHCs in 2 US regions. Click here for full abstract 

Bita Shahrvini, MD; Andrew Chang, MD; Alexandra C. Greb, MD; Mark Baniqued, MD; Divya Prajapati; Rhett Harmon, MD; Nirupama Bonthala, MD; Jenny S. Sauk, MD; Gaurav Syal, MD, MSHS; Folasade (Fola) Popoola May, MD, PhD, MPhil; Berkeley N. Limketkai, MD, PhD

Introduction: Advanced therapies (AT) are effective for inducing remission in inflammatory bowel disease (IBD). A treat-to-target (T2T) approach with close monitoring of symptoms and inflammation is crucial to optimize outcomes. This study investigates the current state of T2T monitoring practices after AT initiation and risk factors for suboptimal monitoring for IBD patients at a large tertiary care center. Click here for full abstract

Bita Shahrvini, MD; Andrew Chang, MD; Alexandra C. Greb, MD; Mark Baniqued, MD; Divya Prajapati; Rhett Harmon, MD; Christina Fasulo, MS, RDN, CNSC; Nirupama Bonthala, MD; Jenny S. Sauk, MD; Gaurav Syal, MD, MSHS; Folasade (Fola) Popoola May, MD, PhD, MPhil; Berkeley N. Limketkai, MD, PhD

Introduction: Patients with inflammatory bowel disease (IBD) have an increased risk of malnutrition. The prevalence of malnutrition is up to 50% among ambulatory IBD patients and has been associated with worse outcomes, prompting recommendations for regular malnutrition risk screening in all IBD patients. This quality improvement (QI) study details a current state analysis of outpatient gastroenterology (GI) malnutrition screening practices for IBD patients at a large, tertiary care center and evaluates risk factors for lack of malnutrition screening. Click here for full abstract

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

Introduction: Assessing disaggregated race and ethnicity data for colorectal cancer (CRC) screening is critical for recognizing and equitably addressing health disparities. However, many data sources lack the granularity necessary to do so. The Uniform Data System (UDS) reports annual quality data for all United States (US) Federally Qualified Health Centers (FQHCs), and for the first time now includes disaggregated data for Hispanic/Latino and Asian demographic groups. To better contextualize CRC screening disparities at FQHCs, we evaluated FQHC CRC screening rates using this disaggregated data. Click here for full abstract

Robert Tamai, MD; Folasade P. May, MD, PhD, MPhil

Introduction: Gastroenterologists routinely provide surveillance colonoscopy interval recommendations based on endoscopic and pathologic findings and 2020 Multi-Society Task Force (MSTF) guidelines. Documentation of these recommendations is critical so that patients undergo the appropriate surveillance to reduce colorectal cancer risk. However, surveillance interval documentation practices are highly variable for clinicians and may impact effective communication of timing of repeat colonoscopy. The aim of our study was to characterize the documentation practices for surveillance intervals among gastroenterologists within a large, academic health center. Click here for full abstract

Robert Tamai, MD; Folasade P. May, MD, PhD, MPhil

Introduction: Appropriate documentation of colonoscopy quality indicators is critical to assess and monitor colonoscopy quality assurance. However, comprehensive documentation is time-consuming, burdensome, and highly variable among clinicians. This variation hinders efforts to accurately capture, measure, and track colonoscopy quality. The aim of our study was to characterize the screening colonoscopy documentations practices for withdrawal time and bowel preparation quality among gastroenterologists within a large, academic health center. Click here for full abstract

Helen Xu, MD; Bita Shahrvini, MD; Nicholas Valle, MD; Vismaya Bachu, MD; Kirstin Peters, MD; Jayraan Badiee, MPH; Brandon Smith, MD; Folasade P. May, MD, PhD, MPhil

Introduction: The fecal immunochemical test (FIT) is a widely used tool for colorectal cancer (CRC) screening. Abnormal results require a follow-up colonoscopy in a two-part screening process. However, data show completion rates as low as 40-60%, likely owing to various barriers such as patient willingness to undergo a procedure, access, and linkage from primary care to gastroenterology. EHR-based clinical dashboards can be powerful tools for aggregating and tracking health system data in real-time to identify gaps in care. This study aimed to validate a feature of a CRC screening dashboard we created at our health system, which tracks colonoscopies for abnormal FIT patients. Click here for full abstract

Introduction: Colorectal cancer (CRC) screening guidelines were updated May 2021 to include individuals age 45-49, owing to an observed increase in CRC incidence in young adults. The impact of this expanded eligibility on efforts to screen 80% of Americans, particularly in communities already facing notable barriers to screening, is poorly understood. Our study investigates the impact of including this new age group on CRC screening rates at all United States (US) Federally Qualified Health Centers (FQHCs). Click here for full abstract

Nicolette J. Rodriguez, MD, MPH; Chinedu Ukaegbu, MBBS, MPH; Susan Regan, PhD; Jessica J. Tuan, MPH; Suzanne Brodney, PhD, MS; Beth Glenn, PhD; Yixuan Zhou; Adjoa Anyane-Yeboa, MD, MPH; Caylin Marotta, MPH; Andrew T. Chan, MD, MPH; Catherine Jeffries; Kelley Le Beaux, MA; Samantha Kuney, MA; Kimberly Schoolcraft; Anjelica Q. Davis, MPPA; Erica T. Warner, ScD, MPH; Beverly Moy, MD, MPH; David A. Drew, PhD; Gina Johnson; Yuchiao Chang, PhD; Jennifer S. Haas, MD, MSc; Folasade P. May, MD, PhD, MPhil; Sapna Syngal, MD, MPH

Introduction: Colorectal cancer (CRC) incidence and mortality disproportionately affect minority racial/ethnic groups. These groups are less likely than White populations to receive appropriate risk assessment, cancer screening and genetic testing. We describe the development and implementation of a CRC risk assessment tool in the Community Collaboration to Advance Racial/Ethnic Equity in Colorectal Cancer Screening (CARES) trial to assess appropriateness of stool based screening and ensure follow-up after abnormal screening test results. 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 tests for colorectal cancer (CRC) are emerging as convenient, non-invasive screening options with potential to improve screening participation and outcomes. Like all non-colonoscopic screening tests, blood-based screening is a two-step process in which individuals with an abnormal result must undergo follow-up colonoscopy (FU-CY). It is unclear if individuals who select blood-based screening are likely to complete this critical second step. To gain insight, we analyzed real-world closed claims data to determine the FU-CY rate after an abnormal blood-based test result and identify predictors of FU-CY. Click here for full abstract

Sigrid S. Young, MD; Jayraan Badiee, MPH: Folasade P. May, MD, PhD, MPhil

Introduction: Despite decreasing incidence, gastric cancer (GC) remains the 4th leading cause of cancer-related deaths worldwide. In the United States (US), routine endoscopic screening for GC in average-risk individuals is not recommended, and most patients present with advanced disease. Five-year survival for GC decreases from 75% in localized disease to 7% in distant metastatic disease. We aimed to determine sociodemographic differences in survival rates in localized vs. metastatic GC. Click here for full abstract

Jamie Yang, MD, Alicia Maehara; Cleo Maehara, MD, MMSC; Alexandria Uy; Odet Kachikian, MHA; Gordon Guyant; Melissa Saul; Jeffrey M. Dueker, MD, MPH; William Hsu, PhD; Folasade P. May, MD, PhD, MPhil; Robert E. Schoen, MD, MPH

Introduction: The optimal surveillance colonoscopy guideline for patients with 1 or 2 non-advanced colorectal adenomas is uncertain. FORTE1 is a national, multicenter clinical trial randomizing participants with 1 or 2 non-advanced adenomas to surveillance colonoscopy at 5 and 10 years versus 10 years. However, clinical trial recruitment is often challenging, as manually identifying eligible participants requires review of large volumes of colonoscopy, pathology, and clinical reports—a process that is resource-intensive and time-consuming, which can hinder trial efficiency. To address this challenge, we developed and evaluated a customized large language model (LLM) that uses artificial intelligence to streamline the identification of potentially eligible trial participants. Click here for full abstract

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