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

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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.

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Acknowledgments

Dr. Partin had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

The study was supported by VA Health Services Research & Development grants #PPO 09-292 (Partin) and #CDA 08-024 (Powell). The funding organization had no role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, One Veterans Drive (2E-152), Minneapolis, MN, 55417, USA

    Melissa R. Partin PhD, Adam A. Powell PhD, Ann Bangerter BS, Krysten Halek MA & David B. Nelson PhD

  2. Department of Medicine, University of Minnesota, Minneapolis, MN, USA

    Melissa R. Partin PhD, Adam A. Powell PhD & David B. Nelson PhD

  3. Center for Organization, Leadership and Management Research, VA Boston Healthcare System, Boston, MA, USA

    James F. Burgess Jr PhD

  4. Boston University School of Public Health, Department of Health Policy and Management, Boston, MA, USA

    James F. Burgess Jr PhD

  5. Health Services Research and Development, Center of Excellence in Primary Care, Durham VA Medical Center, Durham, NC, USA

    Deborah A. Fisher MD

  6. Department of Medicine, Duke University Medical Center, Durham, NC, USA

    Deborah A. Fisher MD

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  1. Melissa R. Partin PhD
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Correspondence to Melissa R. Partin PhD.

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Partin, M.R., Powell, A.A., Bangerter, A. et al. Levels and Variation in Overuse of Fecal Occult Blood Testing in the Veterans Health Administration. J GEN INTERN MED 27, 1618–1625 (2012). https://doi.org/10.1007/s11606-012-2163-9

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  • DOI: https://doi.org/10.1007/s11606-012-2163-9

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