Original Article

Digestive Diseases and Sciences

, Volume 57, Issue 2, pp 288-293

Colorectal Cancer Testing in the National Veterans Health Administration

  • Millie D. LongAffiliated withDivision of Gastroenterology and Hepatology, University of North Carolina at Chapel HillVeterans Health Administration, Office of Patient Care Services, National Center for Health Promotion and Disease Prevention Email author 
  • , Trang LanceAffiliated withVeterans Health Administration, Office of Patient Care Services, National Center for Health Promotion and Disease Prevention
  • , Douglas RobertsonAffiliated withWhite Plains Veterans Affairs Medical Center
  • , Leila KahwatiAffiliated withVeterans Health Administration, Office of Patient Care Services, National Center for Health Promotion and Disease Prevention
  • , Linda KinsingerAffiliated withVeterans Health Administration, Office of Patient Care Services, National Center for Health Promotion and Disease Prevention
  • , Deborah A. FisherAffiliated withHealth Services Research and Development Center of Excellence, Durham Veterans Affairs Medical CenterDivision of Gastroenterology and Hepatology, Duke University

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Abstract

Background

Colorectal cancer (CRC) screening is a priority for the Veteran’s Health Administration (VHA). Optimizing fecal occult blood testing (FOBT) is integral to CRC screening in health care systems.

Aims

The purpose of this study was to characterize the utilization of CRC testing in a large integrated health care system (VHA), determine current rates of CRC testing by FOBT and examine factors associated with lack of FOBT card return.

Methods

The VHA Office of Quality and Performance (OQP) collected data from a national sample of Veterans from October 2008 to September 2009. Rates and modality of CRC testing for eligible Veterans were calculated. Among those offered FOBT, bivariate analyses were performed to describe population characteristics by FOBT return. Logistic regression was used to determine factors independently associated with lack of FOBT return.

Results

A total of 36,336 Veterans were included. On weighted analysis, 80.4% of Veterans received a form of CRC screening. The majority underwent colonoscopy in the prior 10 years (71.6%), followed by FOBT in the prior year (24.0%). A total of 31.0% did not return FOBT cards that were provided. Factors associated with a lack of FOBT return included: younger age, female gender, non-Caucasian race, living in the Northeast, current smoking and lack of influenza vaccination.

Conclusions

Overall rates of CRC screening in VHA are high. Systems-based practices within VHA likely play a role in successful CRC screening. CRC screening is most often via colonoscopy, followed by FOBT. Characteristics associated with non-adherence with FOBT may inform future quality improvement initiatives in health care systems.

Keywords

Colorectal cancer Screening FOBT Colonoscopy Veterans Affairs