Measuring the quality of colorectal cancer screening: The importance of follow-up

David A. Etzioni, Elizabeth M. Yano, Lisa V. Rubenstein, Martin L. Lee, Clifford Y. Ko, Robert H. Brook, Patricia H. Parkerton, Steven M. Asch

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

PURPOSE: As evidence mounts for effectiveness, an increasing proportion of the United States population undergoes colorectal cancer screening. However, relatively little is known about rates of follow-up after abnormal results from initial screening tests. This study examines patterns of colorectal cancer screening and follow-up within the nation's largest integrated health care system: the Veterans Health Administration. METHODS: We obtained information about patients who received colorectal cancer screening in the Veterans Health Administration from an existing quality improvement program and from the Veterans Health Administration's electronic medical record. Linking these data, we analyzed receipt of screening and follow-up testing after a positive fecal occult blood test. RESULTS: A total of 39,870 patients met criteria for colorectal cancer screening; of these 61 percent were screened. Screening was more likely in patients aged 70 to 80 years than in those younger or older. Female gender (relative risk, 0.92; 95 percent confidence interval, 0.9-0.95), Black race (relative risk, 0.92; 95 percent confidence interval, 0.89-0.96), lower income, and infrequent primary care visits were associated with lower likelihood of screening. Of those patients with a positive fecal occult blood test (n = 313), 59 percent received a follow-up barium enema or colonoscopy. Patient-level factors did not predict receipt of a follow-up test. CONCLUSIONS: The Veterans Health Administration rates for colorectal cancer screening are significantly higher than the national average. However, 41 percent of patients with positive fecal occult blood tests failed to receive follow-up testing. Efforts to measure the quality of colorectal cancer screening programs should focus on the entire diagnostic process.

Original languageEnglish (US)
Pages (from-to)1002-1010
Number of pages9
JournalDiseases of the Colon and Rectum
Volume49
Issue number7
DOIs
StatePublished - Jul 2006
Externally publishedYes

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Early Detection of Cancer
Veterans Health
Colorectal Neoplasms
United States Department of Veterans Affairs
Occult Blood
Hematologic Tests
Integrated Delivery of Health Care
Confidence Intervals
Electronic Health Records
Colonoscopy
Quality Improvement
Primary Health Care
Population

Keywords

  • Colorectal neoplasms
  • Delivery of health care
  • Mass screening
  • Quality of health care

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Etzioni, D. A., Yano, E. M., Rubenstein, L. V., Lee, M. L., Ko, C. Y., Brook, R. H., ... Asch, S. M. (2006). Measuring the quality of colorectal cancer screening: The importance of follow-up. Diseases of the Colon and Rectum, 49(7), 1002-1010. https://doi.org/10.1007/s10350-006-0533-2

Measuring the quality of colorectal cancer screening : The importance of follow-up. / Etzioni, David A.; Yano, Elizabeth M.; Rubenstein, Lisa V.; Lee, Martin L.; Ko, Clifford Y.; Brook, Robert H.; Parkerton, Patricia H.; Asch, Steven M.

In: Diseases of the Colon and Rectum, Vol. 49, No. 7, 07.2006, p. 1002-1010.

Research output: Contribution to journalArticle

Etzioni, DA, Yano, EM, Rubenstein, LV, Lee, ML, Ko, CY, Brook, RH, Parkerton, PH & Asch, SM 2006, 'Measuring the quality of colorectal cancer screening: The importance of follow-up', Diseases of the Colon and Rectum, vol. 49, no. 7, pp. 1002-1010. https://doi.org/10.1007/s10350-006-0533-2
Etzioni, David A. ; Yano, Elizabeth M. ; Rubenstein, Lisa V. ; Lee, Martin L. ; Ko, Clifford Y. ; Brook, Robert H. ; Parkerton, Patricia H. ; Asch, Steven M. / Measuring the quality of colorectal cancer screening : The importance of follow-up. In: Diseases of the Colon and Rectum. 2006 ; Vol. 49, No. 7. pp. 1002-1010.
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