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How a safety-net system reached 70% colorectal cancer screening rates
NYC Health + Hospitals streamlined its FIT kit processes, patient education and follow-up care programs to boost colorectal cancer screening rates to 70%.
NYC Health + Hospitals is turning the nation's abysmal cancer screening narrative on its head.
Using a data-driven population health strategy, the safety-net system has achieved a 70% colorectal cancer screening rate, driven in large part by its success in engaging younger patients typically reticent to access preventive screenings.
The program employs a population health dashboard tracking NYC Health + Hospitals patients eligible for a colorectal cancer screening across all of primary care at each of the health system's sites. The registry also tracks how patients are screened -- colonoscopy or fecal immunochemical test (FIT) kits -- and the follow-up care patients might need depending on their screening results.
The program came at a turning point for preventive care in the U.S.
Currently, only 51% of people are accessing routine medical care and cancer screening, according to the most recent numbers from the Prevent Cancer Foundation. For colorectal cancer screening specifically, national screening rates hang at about 59%, per the Colon Cancer Coalition.
According to Stan Kogan, the director of quality improvement initiatives at NYC Health + Hospitals, the health system's program was launched out of necessity, but it also came at a time of great opportunity.
"In 2021, when we started building the registry with our own internal system guidelines, we had also adopted USPSTF's guidance and recommendations," Kogan said in an interview.
That year, the U.S. Preventive Services Task Force updated its colorectal cancer screening guidelines to recommend that individuals begin screening at age 45 rather than 50.
Engaging a younger population who might not know about this change in guidelines or perceive any immediate risk posed a challenge, Kogan noted, but it also created an opportunity for the health system to revamp its population health efforts.
"Because the recommendations had changed, those younger patients in particular had the lowest screening rate to begin with," Kogan explained. "A lot of our emphasis over the last four years has been improving the overall cancer screening rate for colorectal cancer, and especially targeting those younger patients who either are turning 45 or were already in that 45–49 age range and weren't initiating screening as of yet."
By focusing on screening modality, patient education and a smooth path to follow-up care, Kogan said NYC Health + Hospitals has systematized colorectal cancer screening to boost outcomes.
Using FIT kits to improve screening tolerability
There are many reasons why a patient might not get a cancer screening, including confusion about testing guidelines, care access barriers, costs or even fear.
For colorectal cancer screening specifically, Kogan said there's another significant barrier to testing: colonoscopies are infamously unpleasant.
The procedure itself can be invasive, not to mention the preparation a patient must complete to ensure a valid colonoscopy result. According to 2025 surveying, patients are more likely to get a cancer screening when they know there is an at-home test, a less invasive test or a faster/less frequent test they can take.
For a lot of patients, a FIT kit is a better colorectal cancer screening option, Kogan said. The tests are simple, can be completed at home and are good for patients of average risk for the disease.
Using the health system's registry, providers ensured that all eligible patients would be offered a FIT kit or a colonoscopy, but that was only half the battle.
Next, Kogan and his team had to focus on ensuring those FIT kits were completed, returned and followed up on.
Optimizing patient education around FIT kits
Although FIT kits come with instructions, Kogan said they're a lengthy document with complex language in tiny text. These instructions can be hard to understand, he said, and could pose a barrier to completing the test.
"We developed our own materials for patients who are getting a FIT screening," Kogan explained. "Then we translated these materials into 14 different languages. These materials have a lot of big pictures, are patient-friendly and are specific to the FIT kits that we distribute across all of our sites."
In addition to the written instructions, Kogan and his team trained providers to use shared decision-making to determine whether a patient will complete a FIT kit or a colonoscopy.
An essential part of that is explaining the follow-up to an abnormal FIT result, Kogan said. Specifically, clinicians must emphasize that an abnormal FIT result means a patient must undergo a colonoscopy.
Importantly, NYC Health + Hospitals doesn't just send a patient home with a FIT kit and hope it gets returned. Rather, it's set up automated reminders via its MyChart patient portal at two weeks and four weeks after sending the kit home.
"Those are helpful, but they're not a panacea because not everyone looks at MyChart immediately," Kogan pointed out. "We have some facilities that have dedicated resources toward directly contacting patients after the fact."
Each test also comes packaged with a prepaid envelope for patients to drop in the mail and deliver directly to the lab, making it easier for patients to complete their tests.
Ensuring patient engagement in follow-up care
According to Kogan, one of the hardest parts of achieving high colorectal cancer screening rates has been helping patients follow up on abnormal FIT kits with a colonoscopy.
"As you do more FIT screening, you get more positives," he explained, noting that NYC Health + Hospitals' positive rate is 5%.
"You have to make sure that the workflows are there, not just to do the screening, but then to do the follow-up," Kogan added. "We've been developing every step of that pathway, including with the dashboard measures."
Kogan and his team work with primary care, gastroenterology, chief medical officers and other hospital leadership to apply population health strategies to specialty care.
"It's really helpful when system leadership -- particularly site-level leadership, so our chiefs of GI, our ambulatory care chiefs and our chief medical officers -- buy into and trust in the data," Kogan said.
The health system has a spot in its registry to flag patients with positive FIT results and another to track each patient's progress through follow-up. The dashboard spans each of the health system's individual hospital gastroenterology departments to ensure continuity of care.
According to Kogan, it's important to stay data-driven when creating new population health strategies. In doing so, health systems can lead patients with evidence rather than fear, as colorectal cancer incidence continues to rise and, in some cases, cause alarm.
"Colorectal cancer screening age criteria have dropped," Kogan emphasized. "One of the things that you would expect as a result of that is more cancers diagnosed at a younger age as a result of screening, which is a good thing. What you're trying to accomplish with screening is getting cancer diagnosed earlier, not necessarily preventing it altogether."
Sara Heath has reported news related to patient engagement and health equity since 2015.
