Journal of General Internal Medicine

, Volume 27, Issue 12, pp 1618–1625

Levels and Variation in Overuse of Fecal Occult Blood Testing in the Veterans Health Administration

  • Melissa R. Partin
  • Adam A. Powell
  • Ann Bangerter
  • Krysten Halek
  • James F. BurgessJr
  • Deborah A. Fisher
  • David B. Nelson
Original Research

DOI: 10.1007/s11606-012-2163-9

Cite this article as:
Partin, M.R., Powell, A.A., Bangerter, A. et al. J GEN INTERN MED (2012) 27: 1618. doi:10.1007/s11606-012-2163-9

ABSTRACT

BACKGROUND

Policy-makers have called for efforts to reduce overuse of cancer screening tests, including colorectal cancer screening (CRCS). Overuse of CRCS tests other than colonoscopy has not been well documented.

OBJECTIVE

To estimate levels and correlates of fecal occult blood test (FOBT) overuse in a national Veterans Health Administration (VHA) sample.

DESIGN

Observational

PARTICIPANTS

Participants included 1,844 CRCS-eligible patients who responded to a 2007 CRCS survey conducted in 24 VHA facilities and had one or more FOBTs between 2003 and 2009.

MAIN MEASURES

We combined survey data on race, education, and income with administrative data on region, age, gender, CRCS procedures, and outpatient visits to estimate overuse levels and variation. We coded FOBTs as overused if they were conducted <10 months after prior FOBT, <9.5 years after prior colonoscopy, or <4.5 years after prior barium enema. We used multinomial logistic regression models to examine variation in overuse by reason (sooner than recommended after prior FOBT; sooner than recommended after colonoscopy, barium enema, or a combination of procedures), adjusting for clustering of procedures within patients, and patients within facilities.

KEY RESULTS

Of 4,236 FOBTs received by participants, 885 (21 %) met overuse criteria, with 323 (8 %) sooner than recommended after FOBT, and 562 (13 %) sooner than recommended after other procedures. FOBT overuse varied across facilities (9–32 %, p < 0.0001) and region (12–23 %, p < .0012). FOBT overuse after prior FOBT declined between 2003 and 2009 (8 %–5 %, p = .0492), but overuse after other procedures increased (11–19 %, p = .0002). FOBT overuse of both types increased with number of outpatient visits (OR 1.15, p < 0.001), but did not vary by patient demographics. More than 11 % of overused FOBTs were followed by colonoscopy within 12 months.

CONCLUSIONS

Many FOBTs are performed sooner than recommended in the VHA. Variation in overuse by facility, region, and outpatient visits suggests addressing FOBT overuse will require system-level solutions.

KEY WORDS

colorectal neoplasms mass screening utilization clinical practice variation veterans 

Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Melissa R. Partin
    • 1
    • 2
  • Adam A. Powell
    • 1
    • 2
  • Ann Bangerter
    • 1
  • Krysten Halek
    • 1
  • James F. BurgessJr
    • 3
    • 4
  • Deborah A. Fisher
    • 5
    • 6
  • David B. Nelson
    • 1
    • 2
  1. 1.Center for Chronic Disease Outcomes ResearchMinneapolis Veterans Affairs Medical CenterMinneapolisUSA
  2. 2.Department of MedicineUniversity of MinnesotaMinneapolisUSA
  3. 3.Center for Organization, Leadership and Management ResearchVA Boston Healthcare SystemBostonUSA
  4. 4.Boston University School of Public HealthDepartment of Health Policy and ManagementBostonUSA
  5. 5.Health Services Research and Development, Center of Excellence in Primary CareDurham VA Medical CenterDurhamUSA
  6. 6.Department of MedicineDuke University Medical CenterDurhamUSA