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Diagnostic colonoscopy following a positive fecal occult blood test in community health center patients

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Abstract

Purpose

Fecal occult blood testing (FOBT) is a pragmatic screening option for many community health centers (CHCs), but FOBT screening programs will not reduce mortality if patients with positive results do not undergo diagnostic colonoscopy (DC). This study was conducted to investigate DC completion among CHC patients.

Methods

This retrospective cohort study used data from three CHCs in the Midwest and Southwest. The primary study outcome was DC completion within 6 months of positive FOBT among adults age 50–75. Patient data was collected using automated electronic queries. Manual chart reviews were conducted if queries produced no evidence of DC. Poisson regression models described adjusted relative risks (RRs) of DC completion.

Results

The study included 308 patients; 63.3 % were female, 48.7 % were Spanish speakers and 35.7 % were uninsured. Based on combined query and chart review findings, 51.5 % completed DC. Spanish speakers were more likely than English speakers to complete DC [RR 1.19; 95 % confidence interval (CI) 1.04–1.36; P = 0.009], and DC completion was lower among patients with 0 visits than those with 1–2 visits (RR 2.81; 95% CI 1.83–4.33; P < 0.001) or ≥3 visits (RR 3.06; 95% CI 1.57–5.95; P = 0.001).

Conclusions

DC completion was low overall, which raises concerns about whether FOBT can reduce CRC mortality in practice. Further research is needed to understand whether CHC navigator programs can achieve very high DC rates. If organizations use FOBT as their primary CRC screening approach and a substantial number of patients receive positive results, both screening rates and DC rates should be measured.

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Acknowledgments

We thank the following individuals for collecting manual chart review data at each participating community health center: Michelle Johnson, MPH at PCC Community Wellness; Regina Knight at North Country HealthCare, and; Devin Gosberry and Elizabeth Schrier at Erie Family Health Center.

Funding

Funding support was provided by the Agency for Healthcare Research and Quality (No. P01 HS021141).

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Authors and Affiliations

  1. Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th floor, Chicago, IL, 60611, USA

    David T. Liss, Tiffany Brown, Ji Young Lee & David W. Baker

  2. PCC Community Wellness Center, Oak Park, IL, USA

    Marjorie Altergott

  3. Erie Family Health Center, Chicago, IL, USA

    David R. Buchanan

  4. North Country HealthCare, Flagstaff, AZ, USA

    Anne Newland

  5. Alliance of Chicago Community Health Services, Chicago, IL, USA

    Jessica N. Park & Sarah S. Rittner

  6. The Joint Commission, Oakbrook Terrace, IL, USA

    David W. Baker

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  1. David T. Liss
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Correspondence to David T. Liss.

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Liss, D.T., Brown, T., Lee, J.Y. et al. Diagnostic colonoscopy following a positive fecal occult blood test in community health center patients. Cancer Causes Control 27, 881–887 (2016). https://doi.org/10.1007/s10552-016-0763-0

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