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Measuring the Quality of Colorectal Cancer Screening: The Importance of Follow-Up

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Diseases of the Colon & Rectum

Purpose

As evidence mounts for effectiveness, an increasing proportion of the United States population undergoes colorectal cancer screening. However, relatively little is known about rates of follow-up after abnormal results from initial screening tests. This study examines patterns of colorectal cancer screening and follow-up within the nation's largest integrated health care system: the Veterans Health Administration.

Methods

We obtained information about patients who received colorectal cancer screening in the Veterans Health Administration from an existing quality improvement program and from the Veterans Health Administration's electronic medical record. Linking these data, we analyzed receipt of screening and follow-up testing after a positive fecal occult blood test.

Results

A total of 39,870 patients met criteria for colorectal cancer screening; of these 61 percent were screened. Screening was more likely in patients aged 70 to 80 years than in those younger or older. Female gender (relative risk, 0.92; 95 percent confidence interval, 0.9–0.95), Black race (relative risk, 0.92; 95 percent confidence interval, 0.89–0.96), lower income, and infrequent primary care visits were associated with lower likelihood of screening. Of those patients with a positive fecal occult blood test (n = 313), 59 percent received a follow-up barium enema or colonoscopy. Patient-level factors did not predict receipt of a follow-up test.

Conclusions

The Veterans Health Administration rates for colorectal cancer screening are significantly higher than the national average. However, 41 percent of patients with positive fecal occult blood tests failed to receive follow-up testing. Efforts to measure the quality of colorectal cancer screening programs should focus on the entire diagnostic process.

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Acknowledgments

The authors thank Mingming Wang, M.P.H., Ismelda Canelo, Mary Vaiana, Ph.D., and Michael J. Kerr, M.A., M.T.(ASCP.).

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Authors and Affiliations

  1. Department of General Surgery, David Geffen School of Medicine, UCLA, Los Angeles, California, USA

    David A. Etzioni M.D. & Clifford Y. Ko M.D.

  2. VA Greater Los Angeles Health Services Research and Development Center for the Study of Healthcare Provider Behavior, Sepulveda Ambulatory Care Center & Nursing Home, Sepulveda, California, USA

    Elizabeth M. Yano Ph.D., Lisa V. Rubenstein M.D., Martin L. Lee Ph.D., Patricia H. Parkerton Ph.D. & Steven M. Asch M.D.

  3. Department of Health Services, UCLA School of Public Health, Los Angeles, California, USA

    Elizabeth M. Yano Ph.D., Lisa V. Rubenstein M.D., Robert H. Brook Ph.D., Patricia H. Parkerton Ph.D. & Steven M. Asch M.D.

  4. RAND, Health Sciences Program, Santa Monica, California, USA

    Lisa V. Rubenstein M.D., Clifford Y. Ko M.D. & Robert H. Brook Ph.D.

  5. Department of Biostatistics, UCLA School of Public Health, Los Angeles, California, USA

    Martin L. Lee Ph.D.

  6. Department of General Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

    Steven M. Asch M.D.

  7. Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA

    Robert H. Brook Ph.D.

  8. 1015 Ninth Street, Apt 106, Santa Monica, California, 90403, USA

    David A. Etzioni M.D.

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  1. David A. Etzioni M.D.
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  2. Elizabeth M. Yano Ph.D.
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  3. Lisa V. Rubenstein M.D.
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  5. Clifford Y. Ko M.D.
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Additional information

Supported by the Robert Wood Johnson Foundation Clinical Scholars Program (Etzioni), Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D), and National Cancer Institute Colorectal Cancer (CRC) Quality Enhancement Research Initiative (QUERI) Service Directed Research (Project # CRS 02-163).

The views expressed in this article are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation or the Department of Veterans Affairs.

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Etzioni, D.A., Yano, E.M., Rubenstein, L.V. et al. Measuring the Quality of Colorectal Cancer Screening: The Importance of Follow-Up. Dis Colon Rectum 49, 1002–1010 (2006). https://doi.org/10.1007/s10350-006-0533-2

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  • DOI: https://doi.org/10.1007/s10350-006-0533-2

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