for people ages 18 years and up (full criteria)
Healthy Volunteers
healthy people welcome
at San Francisco, California
study started
completion around
Principal Investigator
by Urmimala Sarkar, MD, MPHMa Somsouk, MD, MAS
Headshot of Urmimala Sarkar
Urmimala Sarkar
Headshot of Ma Somsouk
Ma Somsouk



Complete and timely colonoscopy after an abnormal stool-based colorectal cancer screening test results in early detection, cancer prevention, and reduction in mortality, but follow-up in safety-net health systems occurs in less than 50% at 6 months. The proposal will implement multi-level approach consisting of a stepped-wedge clinic-level intervention of team-based best practices co-developed with primary and specialty care, a patient-level technology intervention to provide enhanced instructions and navigation to complete diagnostic colonoscopy, and a mixed methods evaluation to explore multi-level factors contributing to intervention outcomes. Developing a solution to this high-risk and diverse population has the potential to translate to other health systems, support patient self-management, and address other patient conditions.


Follow-up colonoscopy after abnormal stool-based colorectal cancer screening (e.g., fecal immunochemical test (FIT)) results in early detection of colorectal cancer (CRC), prevention of CRC, and reduction in CRC mortality. FIT is a commonly utilized screening test that can be performed at home, is inexpensive, scalable, and often adopted in health systems where colonoscopy resources are scarce. Despite evidence that timely colonoscopy is necessary after an abnormal FIT result, completion of colonoscopy occurs in less than 50% of patients at 6 months and varies significantly by clinic and health systems. In addition to understanding the meaning of an abnormal FIT, three care transitions must occur smoothly for the patient: colonoscopy referral, scheduling, and attendance. However, multilevel factors influence missed follow-up, and multilevel solutions are needed along the care continuum to address clinic-, provider-, and patient-level factors that impair or delay colonoscopy completion.

IMProving Adherence to Colonoscopy through Teams and Technology (IMPACTT), proposes to close gaps and reduce disparities in CRC screening by improving the completion of diagnostic colonoscopy following abnormal FIT in vulnerable populations using a multilevel approach consisting of interventions at the clinic-, provider- and patient-level. The specific aims are 1) to evaluate the effect of a clinic-level intervention targeting primary care providers and staff to adopt "best practices" to support colonoscopy completion in patients with abnormal FIT results, 2) to determine the effect of a patient-level technology intervention with enhanced instructions and navigation for patients with abnormal FIT to complete a diagnostic colonoscopy, and 3) to explore the multilevel implementation factors contributing to intervention outcomes using mixed methods.


Colon Cancer, Cancer Colorectal, Colorectal Cancer, Colorectal Neoplasms, Colonic Neoplasms, BPB, No PIN, BPB, PIN, No BPB, PIN, No BPB, No PIN


You can join if…

Open to people ages 18 years and up

  • Patients with abnormal FIT result
  • Patients ages 18 years or older
  • English, Spanish, or Cantonese speaking

You CAN'T join if...

  • Patients with normal FIT result
  • Patients younger than age 18


  • Zuckerberg San Francisco General Hospital
    San Francisco California 94110 United States

Lead Scientists at UCSF

  • Urmimala Sarkar, MD, MPH
    Urmimala Sarkar MD, MPH is Professor of Medicine at UCSF in the Division of General Internal Medicine, Associate Chair for Faculty Experience for the Department of Medicine, Associate Director of the UCSF Center for Vulnerable Populations, and a primary care physician at Zuckerberg San Francisco General Hospital’s Richard H. Fine People's Clinic.
  • Ma Somsouk, MD, MAS
    1. Leverage electronic health data to implement novel population health services and care coordination for complex populations. We embrace big data and technology to design, develop, and deliver economic and effective services for patients in the area of cancer screening and follow-up. 2.


not yet accepting patients
Start Date
Completion Date
University of California, San Francisco
Study Type
Expecting 2000 study participants
Last Updated