Inadequate Utilization of Diagnostic Colonoscopy Following Abnormal FIT Results in an Integrated Safety-Net System

Details

• Alternative Title:
  Am J Gastroenterol
• Personal Author:
  Issaka, Rachel B. ; Singh, Maneesh H. ; Oshima, Sachiko M. ; Laleau, Victoria J. ; Rachocki, Carly D. ; Chen, Ellen H. ; Day, Lukejohn W. ; Sarkar, Urmimala ; Somsouk, Ma
• Description:
  OBJECTIVES:
  
  The effectiveness of stool-based colorectal cancer (CRC) screening is contingent on colonoscopy completion in patients with an abnormal fecal immunochemical test (FIT). Understanding system and patient factors affecting follow-up of abnormal screening tests is essential to optimize care for high-risk cohorts.
  
  METHODS:
  
  This retrospective cohort study was conducted in an integrated safety-net system comprised of 11 primary-care clinics and one Gastroenterology referral unit and included patients 50–75 years, with a positive FIT between April 2012 and February 2015.
  
  RESULTS:
  
  Of the 2,238 patients identified, 1,245 (55.6%) completed their colonoscopy within 1-year of the positive FIT. The median time from positive FIT to colonoscopy was 184 days (interquartile range 140–232). Of the 13% of FIT positive patients not referred to gastroenterology, 49% lacked documentation addressing their abnormal result or counseling on the increased risk of CRC. Of the patients referred but who missed their appointments, 62% lacked documentation following up on the abnormal result in the absence of a completed colonoscopy. FIT positive patients never referred to gastroenterology or who missed their appointment after referrals were more likely to have comorbid conditions and documented illicit substance use compared with patients who completed a colonoscopy.
  
  CONCLUSIONS:
  
  Despite access to colonoscopy and a shared electronic health record system, colonoscopy completion after an abnormal FIT is inadequate within this safety-net system. Inadequate follow-up is in part explained by inappropriate screening, but there is an absence of clear documentation and systematic workflow within both primary care and GI specialty care addressing abnormal FIT results.
  
  
• Subjects:
  Aged Ambulatory Care Ambulatory Care Facilities Asian Black Or African American Cohort Studies Colonoscopy Colorectal Neoplasms Comorbidity Counseling Documentation Early Detection Of Cancer Ethnicity Feces Female Gastroenterology Hemoglobins Hispanic Or Latino Humans Insurance, Health Language Logistic Models Male Marital Status Middle Aged Multivariate Analysis Primary Health Care Referral And Consultation Retrospective Studies Risk Factors Sex Factors Substance-Related Disorders Time Factors White

  More +
• Source:
  Am J Gastroenterol. 112(2):375-382
• Pubmed ID:
  28154400
• Pubmed Central ID:
  PMC6597438
• Document Type:
  Journal Article
• Funding:
  P30 AI027763/AI/NIAID NIH HHS/United States ; P30 HS023558/HS/AHRQ HHS/United States ; T32 DK007007/DK/NIDDK NIH HHS/United States ; U48 DP004998/DP/NCCDPHP CDC HHS/United States
• Place as Subject:
  San Francisco, CA
• Volume:
  112
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:65472c7332b8cfd20cecdbb6b4f0d9ced79be3b5692b2b89b50babc753ee9c79
• Download URL:
  https://stacks.cdc.gov/view/cdc/79501/cdc_79501_DS1.pdf
• File Type:
  [PDF - 634.15 KB ]