TY - JOUR
T1 - Measuring the quality of colorectal cancer screening
T2 - The importance of follow-up
AU - Etzioni, David A.
AU - Yano, Elizabeth M.
AU - Rubenstein, Lisa V.
AU - Lee, Martin L.
AU - Ko, Clifford Y.
AU - Brook, Robert H.
AU - Parkerton, Patricia H.
AU - Asch, Steven M.
N1 - Funding Information:
Supported by the Robert Wood Johnson Foundation Clinical Scholars Program (David A. Etzioni, M.D.), Department of Veterans Affairs, Health Services Research and Development, and National Cancer Institute Colorectal Cancer, Quality Enhancement Research Initiative, Service Directed Research (Project # CRS 02-163).
PY - 2006/7
Y1 - 2006/7
N2 - 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.
AB - 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.
KW - Colorectal neoplasms
KW - Delivery of health care
KW - Mass screening
KW - Quality of health care
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U2 - 10.1007/s10350-006-0533-2
DO - 10.1007/s10350-006-0533-2
M3 - Article
C2 - 16673056
AN - SCOPUS:33745933864
SN - 0012-3706
VL - 49
SP - 1002
EP - 1010
JO - Diseases of the colon and rectum
JF - Diseases of the colon and rectum
IS - 7
ER -