Diagnostic colonoscopy following a positive fecal occult blood test in community health center patients
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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.
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.
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).
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.
KeywordsColorectal cancer Cancer screening Diagnosis Disparities Preventive care
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 support was provided by the Agency for Healthcare Research and Quality (No. P01 HS021141).
Conflict of interest
The authors declare that they have no conflicts of interest.
- 3.Health Resources and Services Administration 2012 Health Center Data. http://bphc.hrsa.gov/uds/datacenter.aspx?year=2012. Accessed 4 February 2015
- 4.Klabunde CN, Joseph DA, King JB, White A, Plescia M (2013) Vital signs: colorectal cancer screening test use—United States, 2012. MMWR Morb Mortal Wkly Rep 62(44):881–888Google Scholar
- 7.Hoffman RM, Steel S, Yee EF, Massie L, Schrader RM, Murata GH (2010) Colorectal cancer screening adherence is higher with fecal immunochemical tests than guaiac-based fecal occult blood tests: a randomized, controlled trial. Prev Med 50(5–6):297–299. doi: 10.1016/j.ypmed.2010.03.010 CrossRefPubMedGoogle Scholar
- 9.Baker DW, Brown T, Buchanan DR et al (2014) Comparative effectiveness of a multifaceted intervention to improve adherence to annual colorectal cancer screening in community health centers: A randomized clinical trial. JAMA Intern Med 174(8):1235–1241. doi: 10.1001/jamainternmed.2014.2352 CrossRefPubMedGoogle Scholar
- 10.Gupta S, Halm EA, Rockey DC, Hammons M, Koch M, Carter E, Valdez L, Tong L, Ahn C, Kashner M, Argenbright K, Tiro J, Geng Z, Pruitt S, Sugg Skinner C (2013) Comparative effectiveness of fecal immunochemical test outreach, colonoscopy outreach, and usual care for boosting colorectal cancer screening among the underserved: a randomized clinical trial. JAMA Intern Med. doi: 10.1001/jamainternmed.2013.9294 Google Scholar
- 11.Coronado GD, Vollmer WM, Petrik A, Taplin SH, Burdick TE, Meenan RT, Green BB (2014) Strategies and opportunities to STOP colon cancer in priority populations: design of a cluster-randomized pragmatic trial. Contemp Clin Trials 38(2):344–349. doi: 10.1016/j.cct.2014.06.006 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Baig N, Myers RE, Turner BJ, Grana J, Rothermel T, Schlackman N, Weinberg DS (2003) Physician-reported reasons for limited follow-up of patients with a positive fecal occult blood test screening result. Am J Gastroenterol 98(9):2078–2081. doi: 10.1111/j.1572-0241.2003.07575.x CrossRefPubMedGoogle Scholar
- 18.Miglioretti DL, Rutter CM, Bradford SC, Zauber AG, Kessler LG, Feuer EJ, Grossman DC (2008) Improvement in the diagnostic evaluation of a positive fecal occult blood test in an integrated health care organization. Med Care 46(9 Suppl 1):S91–S96. doi: 10.1097/MLR.0b013e31817946c8 CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Raich PC, Whitley EM, Thorland W, Valverde P, Fairclough D (2012) Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population. Cancer Epidemiol Biomark Prev 21(10):1629–1638. doi: 10.1158/1055-9965.EPI-12-0513 CrossRefGoogle Scholar
- 20.Baker DW, Liss DT, Alperovitz-Bichell K, Brown T, Carroll JE, Crawford P, Harigopal P, Henley E, Nelson CA, Rittner SS (2015) Colorectal Cancer Screening Rates at Community Health Centers that Use Electronic Health Records: a cross sectional study. J Health Care Poor Underserved 26(2):377–390. doi: 10.1353/hpu.2015.0030 CrossRefPubMedGoogle Scholar
- 22.List of ICD-9-CM Codes by Chronic Disease Category. Nine Chronic Conditions used in The Dartmouth Atlas of Health Care 2008. March 3, 2008. http://www.dartmouthatlas.org/downloads/methods/chronic_disease_codes_2008.pdf. Accessed 24 February 2015
- 24.Van Meurs KP, Wright LL, Ehrenkranz RA, Lemons JA, Ball MB, Poole WK, Perritt R, Higgins RD, Oh W, Hudak ML, Laptook AR, Shankaran S, Finer NN, Carlo WA, Kennedy KA, Fridriksson JH, Steinhorn RH, Sokol GM, Konduri GG, Aschner JL, Stoll BJ, D’Angio CT, Stevenson DK (2005) Inhaled nitric oxide for premature infants with severe respiratory failure. N Engl J Med 353(1):13–22. doi: 10.1056/NEJMoa043927 CrossRefPubMedGoogle Scholar
- 25.Bah EI, Lamah MC, Fletcher T, Jacob ST, Brett-Major DM, Sall AA, Shindo N, Fischer WA 2nd, Lamontagne F, Saliou SM, Bausch DG, Moumie B, Jagatic T, Sprecher A, Lawler JV, Mayet T, Jacquerioz FA, Mendez Baggi MF, Vallenas C, Clement C, Mardel S, Faye O, Faye O, Soropogui B, Magassouba N, Koivogui L, Pinto R, Fowler RA (2015) Clinical presentation of patients with Ebola virus disease in Conakry. Guinea. N Engl J Med 372(1):40–47. doi: 10.1056/NEJMoa1411249 CrossRefPubMedGoogle Scholar
- 26.Diggle P, Heagerty P, Liang K, Zeger S (2002) Analysis of longitudinal data, 2nd edn. Oxford University Press, NorfolkGoogle Scholar
- 29.Goldman SN, Liss DT, Brown T, Lee JY, Buchanan DR, Balsley K, Cesan A, Weil J, Garrity BH, Baker DW (2015) Comparative effectiveness of multifaceted outreach to initiate colorectal cancer screening in Community Health Centers: a randomized controlled trial. J Gen Intern Med 30(8):1178–1184. doi: 10.1007/s11606-015-3234-5 CrossRefPubMedGoogle Scholar
- 32.National Quality Forum: NQF-Endorsed Measures (QPS) (2014) Colorectal Cancer Screening (COL). http://www.qualityforum.org/Measures_Reports_Tools.aspx. Accessed 2 February 2015
- 35.Doty M, Abrams M, Hernandez S, Stremikis K, Beal A (2010) Enhancing the Capacity of Community Health Centers to Achieve High Performance: Findings from the 2009 Commonwealth Fund National Survey of Federally Qualified Health Centers. The Commonwealth FundGoogle Scholar