Colorectal cancer screening with multitarget-stool DNA testing: real-world adherence and follow-up colonoscopy in a large urban academic health system

Abstract

OBJECTIVE: This real-world study evaluated adherence to multitarget-stool DNA (mt-sDNA) testing and completion of follow-up colonoscopy (FU-CY) among patients aged 45-75 years in NewYork-Presbyterian, a large urban healthcare system. METHODS: This retrospective analysis of tests shipped between 2016 and 2023 linked mt-sDNA data from the Abbott Laboratory Database with Komodo Health administrative claims. Outcomes included mt-sDNA test adherence and completion of FU-CY. Factors associated with these outcomes were evaluated by multivariable logistic regression and Cox proportional hazards regression analyses. RESULTS: Of 7885 mt-sDNA test kits shipped, 70.3% (5543) were completed within 365 days, and 74.5% of patients with positive tests (359/482) completed FU-CY within 365 days; 69.1% completed FU-CY within 180 days. Factors associated with mt-sDNA adherence included traditional Medicare coverage (odds ratio [OR] 2.97; 95% confidence interval [CI] 2.06-4.29; reference: Medicaid), gastroenterologists orders (OR 2.25; 95% CI 1.55-3.26; reference: nurse practitioner/physician assistant), and prior mt-sDNA test return (OR 3.39; 95% CI 2.44-4.72; reference: new patient). Traditional Medicare (hazard ratio [HR] 3.49; 95% CI 1.63-7.44; reference: Medicaid) and email outreach (HR 2.16; 95% CI 1.08-4.32; reference: no digital outreach) were associated with faster FU-CY completion. CONCLUSION: In this large urban academic health system, mt-sDNA adherence and FU-CY completion were substantial, with relevance to emerging Healthcare Effectiveness Data and Information Set measures assessing colonoscopy follow-up after positive noninvasive colorectal cancer screening tests. Insurance-related differences highlight persistent access-related gaps. Email outreach may represent a modifiable strategy to support timely FU-CY completion.