February 17, 2024

No Patient Left Behind: One Doctor’s Quest to Solve a Seemingly Unsolvable Health Problem

When a patient doesn’t show up for a screening, some doctors just move on. This doctor refused to let that happen.

This piece originally appeared on katiecouric.com.

Mount Sinai is one of New York City’s oldest hospitals. Located in East Harlem, the entire Mount Sinai Health System has almost 4,000 beds and sees almost 400,000 patients each year in their emergency department alone. The vast majority of its patients are on government assistance.

Lower-income patients are less likely to visit a doctor for routine cancer screenings, which is a contributing factor to poor health outcomes. Kyle Koster, MD, now an assistant professor of General Internal Medicine at the Icahn School of Medicine at Mount Sinai, always addresses these lifestyle issues with his patients: “Whenever I meet a new patient, I ask about their life outside of healthcare. Where do they live? Where are they from? What do they do for a living?” This strategy helps Dr. Koster to understand a patient’s specific circumstances and any barriers to receiving healthcare, while also building trust.

One major issue many physicians face is getting patients to come in for colon cancer screening. It’s understandable why some patients would put this screening off: The colonoscopy process requires taking a day off work, finding childcare, and securing transportation to and from the procedure.

So in 2019, when Mount Sinai began offering Cologuard®, an at-home colon cancer screening test for adults 45 and older at average risk, the staff at Mount Sinai was hopeful: This test could be done on a patient’s own time and didn’t require a visit to the hospital. But even with these easier screening methods, colorectal cancer screenings at Mount Sinai still hovered below the national average.

Dr. Koster joined the team at Mount Sinai in 2022, and as the then-new kid on the block arriving with fresh ideas, he was asked to help tackle this problem. He recalls learning about the task at hand: “In the year before I arrived at Mount Sinai, a dedicated medical team, Dr. Edward Cytryn, Dr. Zach Stauber, Dr. Nikita Barai, Dr. Steven Itzkowitz, and colorectal cancer screening researcher Lina Jandorf attempted to identify the many barriers to returning these kits,” he says. They then began working with Exact Sciences to figure out a solution. That’s when Dr. Koster came on board.

“On my first day of work, I was told there was this great opportunity to receive a grant,” he recalls. “We’re a hospital that’s known for having an outstanding GI (gastroenterology) department, so getting these screening numbers up was a point of pride for us.”

This grant money would come from an Exact Sciences program known as the Funding Opportunities for CRC Screening Uptake Strategies (FOCUS). The FOCUS program provides grant funding to community organizations, health foundations, public health organizations, and CRC advocacy groups to expand access to colorectal cancer screening and create affordable pathways to follow-up diagnostic care. Dr. Koster agreed to write the grant, which was due in a month; he needed to draw from all the stories he and the team before him had heard from patients to see this issue through their eyes, rather than from the perspective of physicians. He immediately got to work.

When he began looking at the data, Dr. Koster was frustrated: Only about half of the patients prescribed the Cologuard test were actually sending back their kits. He had become a doctor to help people, and the best way to detect cancer early is through screenings, so he was motivated to get people to complete these tests. As Dr. Koster reviewed the information about why patients weren’t returning kits, patterns began to emerge. Some didn’t understand the instructions. Others lived in public housing and had difficulty coordinating deliveries. Many had so much going on in their lives that they simply forgot to return them. “We hypothesized that most of these issues could be solved with a little bit of human support,” says Dr. Koster.

The next big issue was a lack of resources. Doctors were already dealing with full patient loads, and they couldn’t call up every person who’d received a kit to answer their questions and find solutions… but what if someone else could?

Mount Sinai already has a robust population health division, which works closely with internal medicine. It’s built trust and strong relationships between the hospital and the local community. Dr. Koster reached out to population health manager Kayla Jaeckel, MPH, who had already had extensive experience in patient navigation. Together with Jaeckel, Dr. Koster proposed using the grant money to hire a patient coordinator whose full-time job would be getting patients to return their Cologuard kits.

The pair wanted to find a bilingual employee from the local community for the role. This wouldn’t be a doctor or nurse, but a peer — someone who could communicate the Cologuard process in plain language and get a more nuanced understanding of patients’ concerns. When a doctor ordered a Cologuard test for a patient, this coordinator would ensure it got to the patient within 24 hours. She’d then reach out to the patient directly to ask questions: Did they receive the kit? Do they understand the instructions? Do they need help with the return process? Their proposal was reviewed by Exact Sciences, and they were awarded a grant based on the strength of their application and alignment with FOCUS program objectives. They soon hired a coordinator: Jennifer Owens.

Owens dove headfirst into her new role. Since some Mount Sinai patients frequently changed addresses, she ensured that kits were reaching patients at the right place. And while the model before had been that patients would receive automated phone reminders to return the test, Owens decided to call patients directly. “When you get an automated phone call, a lot of us think it’s a scammer, and we just hang up,” says Dr. Koster. “With Jennifer, they’re speaking with someone they already know, so when she tells them it’s time to send the test back, they’re going to listen.”

The project is still in the early stages, so data is limited, but there’s already been an increase in kit returns: from 57 to 67 percent. Dr. Koster has noticed another promising trend: Now that more patients are returning the kits, more doctors are recommending them.

Within the next year, Dr. Koster and his team hope to watch these numbers continue to rise. He’s realized that sometimes, all it takes to get a patient to prioritize their health is a bit of human connection. “I think the grant motivated us to come up with a solution to a problem we might’ve put on the back burner,” says Dr. Koster. “And so far, the results have been incredible.”


All FOCUS program submissions are reviewed via Exact Sciences’ corporate grants process, which is fully independent from sales and marketing activities. Funding decisions are based solely on the strength of the application and alignment with FOCUS Program objectives, without regard to any actual or potential commercial relationships with potential grantees.