Reasons for Lack of Diagnostic Colonoscopy After Positive Result on Fecal Immunochemical Test in a Safety-Net Health System

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• 作者：Jason Martin ; MD^a ; ^b ; Ethan A. Halm ; MD ; MPH^a ; ^b ; ^c ; ^d ; Jasmin A. Tiro ; PhD^c ; ^d ; Zahra Merchant ; ScB^a ; Bijal A. Balasubramanian ; PhD ; MBBS^d ; ^e ; Katharine McCallister ; BA^c ; Joanne M. Sanders ; MS^c ; Chul Ahn ; PhD^c ; ^d ; Wendy Pechero Bishop ; MS^c ; ^d ; Amit G. Singal ; MD ; MS^a ; ^b ; ^c ; ^d ; ^{amit.singal@utsouthwestern.edu}
• 关键词：Colonoscopy ; Colorectal cancer screening ; Fecal immunochemical test ; Randomized controlled trial ; Safety-net health system
• 刊名：The American Journal of Medicine
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：130
• 期：1
• 页码：93.e1-93.e7
• 全文大小：409 K
• 卷排序：130

文摘

Effective colorectal cancer screening depends on timely diagnostic evaluation in patients with abnormal results on fecal immunochemical tests (FITs). Although prior studies suggest low rates of follow-up colonoscopy, there is little information among patients in safety-net health systems and few data characterizing reasons for low follow-up rates. This study aimed to characterize factors contributing to lack of follow-up colonoscopy in a racially diverse and socioeconomically disadvantaged cohort of patients with abnormal results on FIT (“abnormal FIT” for brevity) receiving care in an integrated safety-net health system.MethodsWe performed a retrospective electronic medical record review of patients aged 50-64 years with abnormal FIT at a population-based safety-net health system between January 2010 and July 2013. Review of electronic medical records focused on patients without follow-up colonoscopy to characterize patient-, provider-, and system-level reasons for lack of diagnostic evaluation. We used logistic regression analysis to identify predictors of follow-up colonoscopy within 12 months of abnormal FIT.ResultsOf 1267 patients with abnormal FIT, 536 (42.3%) failed to undergo follow-up colonoscopy within 1 year. Failure was attributable to patient-level factors in 307 (57%) cases, provider factors in 97 (18%) cases, and system factors in 118 (22%) cases. In multivariate analysis, follow-up colonoscopy was less likely among those aged 61-64 years (odds ratio 0.63, 95% confidence interval 0.46–0.87) compared with 50-55 year olds.ConclusionsNearly half (42%) of patients with abnormal FIT failed to undergo follow-up colonoscopy within 1 year. Lack of diagnostic evaluation is related to a combination of patient-, provider-, and system-level factors, highlighting the need for multilevel interventions to improve follow-up colonoscopy completion rates.