Measuring the Quality of Colorectal Cancer Screening: The Importance of Follow-Up |
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Authors: | David A Etzioni MD Elizabeth M Yano PhD Lisa V Rubenstein MD Martin L Lee PhD Clifford Y Ko MD Robert H Brook PhD Patricia H Parkerton PhD Steven M Asch MD |
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Institution: | (1) Department of General Surgery, David Geffen School of Medicine, UCLA, Los Angeles, California, USA;(2) VA Greater Los Angeles Health Services Research and Development Center for the Study of Healthcare Provider Behavior, Sepulveda Ambulatory Care Center & Nursing Home, Sepulveda, California, USA;(3) Department of Health Services, UCLA School of Public Health, Los Angeles, California, USA;(4) RAND, Health Sciences Program, Santa Monica, California, USA;(5) Department of Biostatistics, UCLA School of Public Health, Los Angeles, California, USA;(6) Department of General Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA;(7) Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA;(8) 1015 Ninth Street, Apt 106, Santa Monica, California 90403, USA |
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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.
Supported by the Robert Wood Johnson Foundation Clinical Scholars Program (Etzioni), Department of Veterans Affairs (VA) Health
Services Research and Development (HSR&D), and National Cancer Institute Colorectal Cancer (CRC) Quality Enhancement Research
Initiative (QUERI) Service Directed Research (Project # CRS 02-163).
The views expressed in this article are those of the authors and do not necessarily represent the views of the Robert Wood
Johnson Foundation or the Department of Veterans Affairs. |
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Keywords: | Colorectal neoplasms Mass screening Quality of health care Delivery of health care |
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